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1.
Am J Kidney Dis ; 84(1): 111-119, 2024 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-38458376

RESUMEN

Kidney disease disproportionately impacts people with low socioeconomic status, and low socioeconomic status is associated with worse outcomes for people with kidney disease. Unstable housing, which includes housing insecurity and homelessness, is increasing due to rising housing costs. There is mounting evidence that unstable housing and other health-related social needs are partially driving worse outcomes for people with low socioeconomic status. In this perspective, we consider the challenges to addressing housing for people with kidney disease, such as difficulty with identification of those with unstable housing, strict eligibility criteria for housing support, inadequate supply of affordable housing, and flaws in communities' prioritization of affordable housing. We discuss ways to tailor management for people experiencing unstable housing with kidney disease, and the importance of addressing safety, trauma, and emotional concerns as a part of care. We identify opportunities for the nephrology community to surmount challenges through increased screening, investment in workforce dedicated to community resource navigation, advocacy for investment in affordable housing, restructuring of communities' prioritization of affordable housing, and conducting needed research. Identifying and addressing housing needs among people with kidney disease is critical to eliminating kidney health disparities.


Asunto(s)
Vivienda , Humanos , Personas con Mala Vivienda , Enfermedades Renales/terapia
2.
Am J Kidney Dis ; 83(6): 739-749, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38218454

RESUMEN

RATIONALE & OBJECTIVE: People with low socioeconomic status are disproportionately affected by kidney failure, and their adverse outcomes may stem from unmet health-related social needs. This study explored hemodialysis patient perspectives on health-related social needs and recommendations for intervention. STUDY DESIGN: Qualitative study using semistructured interviews. SETTINGS & PARTICIPANTS: Thirty-two people with low socioeconomic status receiving hemodialysis at 3 hemodialysis facilities in Austin, Texas. ANALYTICAL APPROACH: Interviews were analyzed for themes and subthemes using the constant comparative method. RESULTS: Seven themes and 21 subthemes (in parentheses) were identified: (1) kidney failure was unexpected (never thought it would happen to me; do not understand dialysis); (2) providers fail patients (doctors did not act; doctors do not care); (3) dialysis is detrimental (life is not the same; dialysis is all you do; dialysis causes emotional distress; dialysis makes you feel sick); (4) powerlessness (dependent on others; cannot do anything about my situation); (5) financial resource strain (dialysis makes you poor and keeps you poor; disability checks are not enough; food programs exist but are inconsistent; eat whatever food is available; not enough affordable housing; unstable housing affects health and well-being); (6) motivation to keep going (faith, support system, will to live); and (7) interventions should promote self-efficacy (navigation of community resources, support groups). LIMITATIONS: Limited quantitative data such as on dialysis vintage, and limited geographic representation. CONCLUSIONS: Dialysis exacerbates financial resource strain, and health-related social needs exacerbate dialysis-related stress. The participants made recommendations to address social needs with an emphasis on increasing support and community resources for this population. PLAIN-LANGUAGE SUMMARY: People receiving dialysis often experience health-related social needs, such as food and housing needs, but little is known about how these impact patients' health and well-being or how to best address them. We interviewed people receiving dialysis about how health-related social needs affect them and what they think dialysis facilities can do to help them address those needs. The participants reported that they often lose their independence after starting dialysis and health-related social needs are common, exacerbate their stress and emotional distress, and reduce their sense of well-being. Dialysis facilities may be able to enhance the experience of these patients by facilitating connections with local resources and providing opportunities for patients to support one another.


Asunto(s)
Investigación Cualitativa , Diálisis Renal , Humanos , Masculino , Femenino , Diálisis Renal/psicología , Persona de Mediana Edad , Anciano , Fallo Renal Crónico/terapia , Fallo Renal Crónico/psicología , Adulto , Necesidades y Demandas de Servicios de Salud , Evaluación de Necesidades , Texas , Entrevistas como Asunto
3.
J Am Soc Nephrol ; 34(11): 1812-1818, 2023 11 01.
Artículo en Inglés | MEDLINE | ID: mdl-37729392

RESUMEN

ABSTRACT: Latinx populations face a higher burden of kidney failure and associated negative outcomes compared with non-Latinx White populations, despite sharing a similar prevalence of CKD. Community health worker (CHW) interventions have been shown to improve outcomes for Latinx individuals, but they are largely underutilized in kidney disease. We convened a workshop of four ongoing kidney disease CHW programs to identify successes, challenges, potential solutions, and needed research to promote CHW programs for Latinx individuals with kidney disease. Key points from the workshop and recommendations for intervention and research are highlighted. Facilitators of program success included prioritizing trust-building with participants, enabling participants to determine what aspects of the intervention were needed, providing participants with tools to help themselves and others after the intervention, and taking a trauma-informed approach to relationships. Challenges included persistent systemic barriers despite successful care navigation and low recruitment and retention. Research is needed to capture the effect of CHW interventions on outcomes and to determine how to implement CHW interventions for people with kidney disease nationwide.


Asunto(s)
Enfermedades Renales , Nefrología , Humanos , Agentes Comunitarios de Salud , Enfermedades Renales/terapia
4.
Semin Dial ; 33(1): 43-51, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31899828

RESUMEN

Socially disadvantaged persons, including racial and ethnic minorities, individuals with low incomes, homeless persons, and non-US citizens bear a disproportionate burden of end-stage kidney disease (ESKD). Inequities in nephrology referral, vascular access, use of home dialysis modalities, kidney transplantation, and mortality are prominent. Public policies, including the Patient Protection and Affordable Care Act, end-stage renal disease Quality Incentive Program, and the Prospective Payment System, were enacted to improve healthcare access and dialysis care. Here, we highlight inequities in dialysis care and outcomes, how current ESKD and other public policies may influence or exacerbate these inequities, and gaps in the literature needed to inform future policies toward achieving equity in ESKD. We give special attention to the 2019 Advancing American Kidney Health Executive Order, which has high potential to radically transform dialysis care.


Asunto(s)
Política de Salud/legislación & jurisprudencia , Accesibilidad a los Servicios de Salud/organización & administración , Disparidades en Atención de Salud/legislación & jurisprudencia , Fallo Renal Crónico/terapia , Diálisis Renal , Disparidades en el Estado de Salud , Humanos , Fallo Renal Crónico/epidemiología , Estados Unidos/epidemiología
8.
Dis Colon Rectum ; 56(12): 1403-8, 2013 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-24201395

RESUMEN

BACKGROUND: Surgical site infections in colorectal surgery remain a common problem, and are associated with an increase in cost of care and length of stay. OBJECTIVE: This study aims to evaluate the effect of known risk factors and the use of incisional negative pressure wound therapy on surgical site infection rates. DESIGN: This is a single-center retrospective study with the use of chart review. SETTINGS: The study took place at a tertiary academic medical center. PATIENTS: All patients undergoing open colectomy at a single institution from 2009 through 2011 were studied. MAIN OUTCOME MEASURES: The primary outcome measured was the presence or absence of surgical site infection. RESULTS: Overall, 69 of the 254 patients (27.2%) experienced surgical site infection; 4 (12.5%) surgical site infections were seen in patients undergoing incisional negative pressure wound therapy and 65 (29.3%) were seen in patients undergoing standard closure. Multiple logistic regression revealed 2 significant factors: diabetes mellitus increased the chance of surgical site infection (OR, 1.98; p < 0.05), and the use of incisional negative pressure wound therapy decreased the chance of surgical site infection (OR, 0.32; p < 0.05). Obesity was associated with a trend toward increasing surgical site infection (OR, 1.64; p = 0.10). LIMITATIONS: This study is limited by its retrospective nature and the high baseline prevalence of surgical site infection. CONCLUSIONS: Incisional negative pressure wound therapy appears to reduce surgical site infection in open colorectal surgery. Further study may be helpful to identify patient populations who would have the greatest benefit from this technique(see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A115).


Asunto(s)
Colectomía/métodos , Terapia de Presión Negativa para Heridas/métodos , Infección de la Herida Quirúrgica/prevención & control , Adulto , Anciano , Anciano de 80 o más Años , Colectomía/efectos adversos , Diabetes Mellitus , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Obesidad , Estudios Retrospectivos , Factores de Riesgo , Adulto Joven
9.
Kidney Med ; 5(8): 100679, 2023 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-37520781

RESUMEN

Rationale and Objective: Latinx individuals are at a higher risk for kidney failure than non-Latinx White individuals; however, they are less likely to receive pre-kidney failure medical care. The objective of this study was to determine the feasibility and acceptability of a community health worker (CHW) intervention that facilitated access to medical care for Latinx individuals. Study Design: Single-arm prospective study. Setting and Participants: Latinx adults were found to have albuminuria or risk factors for kidney disease at community screening events in Austin, Texas. Intervention: A 6-month CHW intervention that facilitated the following: (1) obtaining medical insurance; (2) medical care coordination with primary and nephrology care; (3) kidney disease education; and (4) connection with local resources to address health-related social needs. Outcomes: Recruitment, retention, medical care linkage, and participant and CHW-reported satisfaction with the intervention. Results: Of the 173 individuals who attended the 2 community screening events, 49 agreed to participate in the study, of whom, 51% were men with a mean ± standard deviation (SD) age of 45 ± 14 years, and all self-identified as Mexican or Chicano. The mean ± SD estimated glomerular filtration rate (eGFR) was 110 ± 21 mL/min/1.73 m2 and 41% of the participants reported a urine albumin-creatinine ratio of ≥30 mg/g. Among those enrolled, 28 of the 49 (57%) completed at least 1 CHW visit, and 20 of 49 (41%) completed the intervention. 7 individuals who needed assistance with insurance obtained insurance, and 15 of 20 (75%) scheduled an appointment with a primary care physician within 180 days. Participants reported that the US health care previously seemed inaccessible but gained insurance, the ability to navigate the system, and the ability to help others in their community to access medical care because of the program. Limitations: Small sample size and a single community may limit generalizability. Conclusions: We reported the acceptability of a CHW intervention. We encountered challenges with feasibility and identified strategies to overcome them. Studies are needed to test the effect of CHW interventions on outcomes and kidney health disparities. Funding: National Kidney Foundation young investigator research grant to Dr Novick. Plain Language Summary: Latinx individuals are at a higher risk for kidney failure than non-Latinx White individuals; however, they are less likely to receive pre-kidney failure medical care. We piloted a community health worker intervention that connected people with risk factors or showed evidence of kidney dysfunction at community screening events with medical care. Our findings indicate the acceptability of the intervention. We encountered challenges with feasibility and identified strategies to overcome them.

10.
JAMA Netw Open ; 6(11): e2344448, 2023 Nov 01.
Artículo en Inglés | MEDLINE | ID: mdl-37988075

RESUMEN

Importance: Housing status is an important health determinant, yet little is known about unstable housing among individuals receiving dialysis. Objective: To determine factors associated with unstable housing among US veterans receiving dialysis and to estimate the association of unstable housing with risk of death. Design, Setting, and Participants: This retrospective cohort study used data from the US Veterans Health Administration (VHA) and the US Renal Data System for patients who initiated dialysis between October 1, 2012, and December 31, 2018. Veterans were included if they used VHA outpatient services and completed 1 or more unstable housing screenings within a 3-year period before starting dialysis. Data analysis was conducted from January 24 to June 16, 2023. Exposures: Unstable housing was defined as self-report of not having stable housing within the past 2 months or having concerns about stable housing in the next 2 months. Main Outcomes and Measures: The main outcome was all-cause mortality. Characteristics associated with unstable housing at the time of dialysis initiation were examined. The multivariate Fine and Gray cumulative incidence model was used, treating transplant as a competing risk and age as an effect modifier, to examine the risk of death associated with unstable housing. Results: This study included 25 689 veterans, with a median age of 68 (IQR, 62-74) years. Most participants were men (98%), and more than half (52%) were White. There were 771 veterans (3%) with a positive screen for unstable housing within a 3-year period before starting dialysis. Compared with veterans with stable housing, those with unstable housing were younger (mean [SD] age, 61 [8] vs 68 [10] years), were more likely to be Black (45% vs 32%) or Hispanic (9% vs 7%), and were more likely to start dialysis with a central venous catheter (77% vs 66%), receive in-center hemodialysis (96% vs 91%), and have non-Medicare insurance (53% vs 28%). Factors associated with unstable housing included Hispanic ethnicity, non-arteriovenous fistula vascular access, lack of predialysis nephrology care, and non-Medicare insurance. Veterans with unstable housing had higher all-cause mortality (adjusted hazard ratio [AHR], 1.20 [95% CI, 1.04 to 1.37] for a median age of 68 years), and risks increased with age (P = .01 for interaction). In age-stratified analyses, unstable housing was associated with higher mortality among veterans aged 75 to 85 years (AHR, 1.64 [95% CI, 1.18 to 2.28]), but associations were not observed for other age groups. Conclusions and Relevance: In this cohort study of veterans receiving dialysis, unstable housing experienced before starting dialysis was associated with increased risk of all-cause mortality, and risks increased with age. Further efforts are needed to understand the experiences of older adults with unstable housing and to estimate the scope of unstable housing among all individuals receiving dialysis.


Asunto(s)
Diálisis Renal , Veteranos , Masculino , Humanos , Anciano , Persona de Mediana Edad , Femenino , Estudios de Cohortes , Vivienda , Estudios Retrospectivos , Radiofármacos
11.
Kidney Med ; 4(4): 100443, 2022 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-35372820

RESUMEN

Stable housing is essential for health. Over 580,000 Americans experienced homelessness during one night in 2020, and over 37 million households spend over 30% of their income on housing. Unstable housing has been associated with mortality, acute care utilization, communicable and non-communicable diseases, a higher risk of kidney disease, and kidney disease progression. In this review, we define various forms of unstable housing, provide an overview of the interaction between unstable housing and health, and discuss existing evidence associating housing and kidney disease. We provide historical context for unstable housing in the United States, and detail policy, community, and individual-level factors that contribute to the risk of unstable housing. Unstable housing likely affects kidney health via a complex interplay of individual and structural factors. Various screening tools are available for use by providers. Special considerations should be made when working with individuals experiencing unstable housing to meet their unique needs, facilitate health care engagement, and optimize outcomes. Housing interventions have been shown to improve outcomes and should be examined for their role in kidney disease.

12.
Womens Health Rep (New Rochelle) ; 2(1): 149-153, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34085056

RESUMEN

Introduction: Women have historically been under-represented in medical literature, particularly prominent in authorship of invited commentaries. With the instantaneous change in work environment forcing Americans to adapt to working at home, many theorize that women will be more adversely affected due to traditional concepts of women being more responsible for the home in addition to work responsibilities. Objective: Understand how women contributed to coronavirus disease 2019 (COVID-19) literature early in the pandemic. Methods: Cross-sectional analysis of manuscripts published in three high-impact U.S. medical journals from February to May 2020 was performed. We used log-binomial regression to examine for an association between COVID-19 status and likelihood of having at least one female first author, and evaluated for effect modification according to whether the manuscript was invited. Results: Among 980 manuscripts, 313 (31.9%) listed at least one female first author, 203 were written on COVID-19 (20.7%), and 144 (14.7%) were invited. There was no association between COVID-19 status and having at least one female first author overall (adjusted risk ratio [RR] 0.93, 95% confidence interval [CI] 0.72-1.19). The relationship between COVID-19 status and first-author sex was 0.23 (95% CI 0.06-0.92) for invited manuscripts and 1.04 (95% CI 0.81-1.35) for noninvited manuscripts (p for interaction 0.02). Discussion: We demonstrate that women were not less likely to be first authors on COVID-19 manuscripts but were less likely to be first authors on invited COVID-19 manuscripts. Early career female researchers are the most vulnerable for inability to meet metrics for promotion, accounting for the continued under-representation of women in senior academic roles. COVID-19 has the potential to exacerbate this disparity.

13.
Semin Nephrol ; 41(6): 563-573, 2021 11.
Artículo en Inglés | MEDLINE | ID: mdl-34973700

RESUMEN

Black and Latinx individuals in the United States are afflicted disproportionately with kidney disease. Because of structural racism, social risk factors drive disparities in disease prevalence and result in worse outcomes among these patient groups. The impact of social and economic oppression is pervasive in physical and emotional aspects of health. In this review, we describe the history of race and ethnicity among black and Latinx individuals in the United States and discuss how these politicosocial constructs impact disparities in well-being and mental health. Lastly, we outline future research, clinical considerations, and policy considerations to eliminate racial and ethnic disparities in well-being among black and Latinx individuals with kidney disease.


Asunto(s)
Enfermedades Renales , Salud Mental , Etnicidad , Femenino , Humanos , Enfermedades Renales/epidemiología , Masculino , Prevalencia , Racismo Sistemático , Estados Unidos/epidemiología
14.
JAMA Netw Open ; 4(9): e2124658, 2021 09 01.
Artículo en Inglés | MEDLINE | ID: mdl-34499133

RESUMEN

Importance: In most states, undocumented Latinx immigrants with kidney failure receive dialysis in acute care settings on an emergency-only basis. How much kidney disease education Latinx immigrants receive and how to improve kidney disease education and outreach among Latinx populations are unknown. Objective: To understand the kidney disease educational gaps of Latinx individuals who need but lack access to scheduled outpatient dialysis. Design, Setting, and Participants: This qualitative study used semistructured interviews in a Texas hospital system from March 2020 to January 2021 with 15 individuals who received emergency-only dialysis when they were first diagnosed with kidney failure. Demographic information was collected, and a thematic analysis was performed using the constant comparative method on interviews after they were audio-recorded, translated, and transcribed verbatim. Data analysis was performed from April 2020 to February 2021. Main Outcomes and Measures: Subthemes and themes from semistructured interviews. Results: All 15 persons interviewed (9 male individuals [60%]; mean [SD] age, 51 [17] years) identified as Hispanic, 11 (73%) were born in Mexico, and none reported knowing about their kidney disease more than 6 months before starting dialysis. The themes identified were (1) lack of kidney disease awareness, (2) education provided was incomplete and poor quality, (3) lack of culturally concordant communication and care, (4) elements that Latinx patients receiving emergency-only dialysis want in their education, (5) facilitators of patient activation and coping, and (6) Latinx patient recommendations to improve community outreach. Conclusions and Relevance: Latinx adults receiving emergency-only dialysis are usually unaware of their kidney disease until shortly before or after they start dialysis, and the education they receive is poor quality and often not culturally tailored. Participants made feasible recommendations on how to improve education and outreach among Latinx communities.


Asunto(s)
Hispánicos o Latinos/psicología , Fallo Renal Crónico/psicología , Educación del Paciente como Asunto , Diálisis Renal/psicología , Inmigrantes Indocumentados/psicología , Adaptación Psicológica , Comunicación , Asistencia Sanitaria Culturalmente Competente , Servicio de Urgencia en Hospital , Femenino , Conocimientos, Actitudes y Práctica en Salud , Accesibilidad a los Servicios de Salud , Humanos , Masculino , Persona de Mediana Edad , Investigación Cualitativa , Texas
15.
Adv Chronic Kidney Dis ; 27(5): 427-433, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-33308509

RESUMEN

Racial, ethnic, socioeconomic, age, and sex-related health disparities in kidney disease are prominent in the United States. The Coronavirus Disease 2019 (COVID-19) pandemic has disproportionately affected marginalized populations. Older adults, people experiencing unstable housing, racial and ethnic minorities, and immigrants are potentially at increased risk for infection and severe complications from COVID-19. The direct and societal effects of the pandemic may increase risk of incident kidney disease and lead to worse outcomes for those with kidney disease. The rapid transition to telemedicine potentially limits access to care for older adults, immigrants, and people experiencing unstable housing. The economic impact of the pandemic has had a disproportionate effect on women, minorities, and immigrants, which may limit their ability to manage kidney disease and lead to complications or kidney disease progression. We describe the impact of COVID-19 on marginalized populations and highlight how the pandemic may exacerbate existing disparities in kidney disease.


Asunto(s)
COVID-19/epidemiología , Estatus Económico/estadística & datos numéricos , Emigrantes e Inmigrantes/estadística & datos numéricos , Etnicidad/estadística & datos numéricos , Disparidades en el Estado de Salud , Disparidades en Atención de Salud/estadística & datos numéricos , Personas con Mala Vivienda/estadística & datos numéricos , Enfermedades Renales/epidemiología , Factores de Edad , COVID-19/etnología , Equidad en Salud , Disparidades en Atención de Salud/etnología , Humanos , Enfermedades Renales/etnología , Refugiados/estadística & datos numéricos , SARS-CoV-2 , Factores Sexuales , Clase Social , Inmigrantes Indocumentados/estadística & datos numéricos , Estados Unidos/epidemiología
16.
Kidney360 ; 1(4): 241-247, 2020 04 30.
Artículo en Inglés | MEDLINE | ID: mdl-35372916

RESUMEN

Background: Housing insecurity is characterized by high housing costs or unsafe living conditions that prevent self-care and threaten independence. We examined the relationship of housing insecurity and risk of kidney disease. Methods: We used longitudinal data from the Healthy Aging in Neighborhoods of Diversity across the Life Span study (Baltimore, MD). We used multivariable regression to quantify associations between housing insecurity and rapid kidney function decline (loss of >5 ml/min per 1.73 m2 of eGFR per year) and, among those without kidney disease at baseline, incident reduced kidney function (eGFR <60 ml/min per 1.73 m2) and incident albuminuria (urine albumin-creatinine ratio [ACR] ≥30 mg/g). Results: Among 1262 participants, mean age was 52 years, 40% were male and 57% were black. A total of 405 (32%) reported housing insecurity. After a median of 3.5 years of follow-up, rapid kidney function decline, incident reduced kidney function, and incident albuminuria occurred in 199 (16%), 64 (5%), and 74 (7%) participants, respectively. Housing insecurity was associated with increased odds of incident albuminuria (unadjusted OR, 2.04; 95% CI, 1.29 to 3.29; adjusted OR, 3.23; 95% CI, 1.90 to 5.50) but not rapid kidney function decline or incident reduced kidney function. Conclusions: In this urban population, housing insecurity was associated with increased risk of subsequent albuminuria. Increased recognition of housing insecurity as a social determinant of kidney disease is needed, and risk-reduction efforts that specifically target populations experiencing housing insecurity should be considered.


Asunto(s)
Inestabilidad de Vivienda , Insuficiencia Renal Crónica , Tasa de Filtración Glomerular , Humanos , Riñón , Masculino , Persona de Mediana Edad , Insuficiencia Renal Crónica/epidemiología , Factores de Riesgo
17.
Semin Nephrol ; 39(3): 256-262, 2019 05.
Artículo en Inglés | MEDLINE | ID: mdl-31054624

RESUMEN

Chronic kidney disease (CKD) hotspots are defined as countries, regions, communities, or ethnicities with a higher than average incidence of CKD when compared with the worldwide, country, or regional rates. Here, we describe what is known about socially determined CKD hotspots, that is, the burden of CKD among socially defined communities that often collocate geographically. We focus on the poor, the homeless, and the food insecure, and their intersection with other social determinants of health, including race/ethnicity. In addition to discussing the burden of CKD in these communities, we describe some efforts to mitigate this burden and identify gaps in current knowledge.


Asunto(s)
Abastecimiento de Alimentos , Personas con Mala Vivienda , Pobreza , Insuficiencia Renal Crónica/epidemiología , Determinantes Sociales de la Salud , Humanos , Fallo Renal Crónico/epidemiología , Prevalencia , Insuficiencia Renal Crónica/etnología
18.
Clin J Am Soc Nephrol ; 14(11): 1581-1589, 2019 11 07.
Artículo en Inglés | MEDLINE | ID: mdl-31582462

RESUMEN

BACKGROUND AND OBJECTIVES: Most opioids undergo kidney excretion. The goal of this study was to evaluate opioid-associated risks of death and hospitalization across the range of eGFR. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: The study population included adult primary care patients in Geisinger Health (Danville, PA) between 2008 and 2017. People receiving their first opioid prescription were propensity matched to people receiving NSAIDS (and, in sensitivity analysis, gabapentinoids) and the risk of death and hospitalization were compared, classifying opioid medication exposure as time-varying daily oral morphine milligram equivalents (MMEs) across time-varying eGFR. RESULTS: The propensity-matched cohort included 46,246 patients prescribed either opioids or NSAIDs between 2008 and 2017 (mean [SD] age, 54 [16] years; 56% female; 3% of black race). Prescriptions for 1-59 and ≥60 MMEs were associated with higher risk of death (HR, 1.70; 95% CI, 1.41 to 2.05 for 1-59 MMEs; HR, 2.25; 95% CI, 1.82 to 2.79 for ≥60 MMEs) and hospitalization (HR, 1.38; 95% CI, 1.30 to 1.46 for 1-59 MMEs; HR, 1.68; 95% CI, 1.56 to 1.81 for ≥60 MMEs) compared with NSAID prescriptions, when evaluated at eGFR 80 ml/min per 1.73 m2. The relative risk of death associated with ≥60 MMEs was higher at lower GFR (e.g., eGFR, 40 ml/min per 1.73 m2; HR, 3.94; 95% CI, 2.70 to 5.75; P for interaction, 0.01). When gabapentinoids were used as the comparison medication, only ≥60 MMEs were significantly associated with higher risk of death (HR, 2.72; 95% CI, 1.71 to 4.34), although both 1-59 and ≥60 MMEs were associated with risk of hospitalization (HR, 1.22; 95% CI, 1.04 to 1.43 for 1-59 MMEs; HR, 1.54; 95% CI, 1.28 to 1.86 for ≥60 MMEs). CONCLUSIONS: The receipt of prescription opioids was associated with a higher risk of death and hospitalization compared with other pain medications, particularly with higher doses and at lower eGFR.


Asunto(s)
Analgésicos Opioides/efectos adversos , Tasa de Filtración Glomerular/fisiología , Adulto , Anciano , Antiinflamatorios no Esteroideos/efectos adversos , Causas de Muerte , Estudios de Cohortes , Sobredosis de Droga/mortalidad , Prescripciones de Medicamentos , Femenino , Hospitalización , Humanos , Masculino , Persona de Mediana Edad
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