Opioid use is more strongly associated with adverse events than non-steroidal anti-inflammatory drug (NSAID) use among patients with chronic kidney disease, new study findings suggest.

In a study of 3939 participants in the Chronic Renal Insufficiency Cohort (CRIC) study, investigators found that time-updated cumulative opioid use, compared with nonuse, was significantly associated with a 1.4-fold increased risk of a kidney disease composite outcome of a 50% reduction in glomerular filtration rate (GFR) from baseline or kidney failure requiring kidney replacement therapy (KRT), after adjusting for time-dependent covariates. Opioid use also was significantly associated with 1.4-, 1.5- and 1.7-fold increased risks for kidney failure with KRT, pre-kidney failure death, and hospitalization, respectively, a team led by Jeffrey C. Fink, MD, MS, of the University of Maryland School of Medicine in Baltimore, reported in the American Journal of Kidney Diseases. Similar results emerged from an analysis restricted to a subcohort of participants reporting ever using other analgesics (nonopioid and non-NSAID) or tramadol. In that subcohort, opioid use, compared with nonuse, was significantly associated with 1.6-, 1.5-, 1.6-, and 1.7-fold increases risks for the kidney disease composite outcome, kidney failure with KRT, pre-kidney failure death, and hospitalization, respectively.

Time-updated cumulative NSAID use in the full cohort, compared with nonuse, was significantly associated with a 1.2-fold increased risk for the kidney disease composite outcome and 1.1-fold increased risk of hospitalization. Among black individuals, however, NSAID users had a significant 1.3-fold increased risk of the kidney disease composite outcome compared with nonusers. In the subcohort, the investigator found no significant association between NSAID use and any of these outcomes.

In the overall cohort, NSAID use was not significantly associated with kidney failure with KRT and pre-kidney failure death. It was, however, significantly associated with a lower risk of kidney failure with KRT among women and individuals with a GFR below 45 mL/min/1.73 m2. The risks were reduced by 37% and 23% in these groups, respectively.


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“In conclusion, our study findings suggest that opioid use is associated with greater harm the NSAIDs, with a substantial increase in risk for death and poor kidney outcomes,” the authors wrote.

The cohort had a median of 6.84 years of follow-up. Of the 3939 participants, 391 (9.9%) and 612 (15.5%) reported baseline use of opioids and NSAIDs, respectively.

Reference

Zhan M, Doerfler RM, Xie D, et al. Association of opioids and nonsteroidal anti-inflammatory drugs with outcomes in CKD: Findings from the CRIC (Chronic Renal Insufficiency Cohort) study [published online April 18, 2020]. Am J Kidney Dis.   doi: 10.1053/j.ajkd.2019.12.010