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Original ArticlesEpidemiology and Outcomes
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Opioid and Benzodiazepine Use in End-Stage Renal Disease: A Systematic Review

Ahraaz Wyne, Raman Rai, Meaghan Cuerden, William F. Clark and Rita S. Suri
CJASN February 2011, 6 (2) 326-333; DOI: https://doi.org/10.2215/CJN.04770610
Ahraaz Wyne
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Raman Rai
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Meaghan Cuerden
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William F. Clark
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Rita S. Suri
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  • Figure 1.
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    Figure 1.

    Flow diagram of included studies.

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    Figure 2.

    Prevalence of opioid use. 1 indicates studies that overlap in time and population.

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    Figure 3.

    Prevalence of benzodiazepine use. 1 and 2 indicate studies that overlap in time and population.

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    Table 1.

    Quality of included studies

    Number of Studies (Total = 15)
    Representativeness
        study sample represents the community of dialysis patients well13 (87%)
        study collects data prospectively13 (87%)
        comparison cohorts, if present, are drawn from the same source3 (20%)a
        study reports clear inclusion and exclusion criteria14 (93%)
        study measures actual use of opioids and benzodiazepines (versus prescription)1 (7%)
        study includes prevalent and incident patients6 (40%)
        all patients in the study are accounted for, and attrition was <20%4 (27%)
    Results
        study reports baseline characteristics (e.g., age, gender, comorbidities)14 (93%)
        study reports reasons for prescription of opioids and benzodiazepines1 (7%)
        study reports effectiveness of opioids and benzodiazepines2 (7%)
        adverse events associated with opioid/benzodiazepine use reported7 (47%)
    • ↵a Comparison cohort not applicable in the other 12 studies.

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    Table 2.

    Baseline characteristics of study populations

    StudyPeriodCountryPopulationDialysis UnitsNDialysis Duration (years)Mean Age (years)Male (%)ComorbiditiesBenzodiazepine UseOpioid UseUpper 95% CI
    Black (%)HTCVDPVDDBN%Lower 95% CIUpper 95% CIN%Lower 95% CI
    Opioids
        Elder (2008)1996–2001Intl.DOPPS I prev.30863213.1559 ± 14.5581572.514.019.630.0178228.227.129.3
        Bailey (2006)2000Intl.DOPPS I prev.30884554.9 ± 5.460 ± 14.7573873.115.421.332.98039.58.910.1
        Bailey (2004)1997USDOPPS I prev.14229983.4 ± 3.860.6 ± 15.5533884.118.326.246.253818.016.719.4
    2000USDOPPS I prev.14224763.4 ± 3.860.6 ± 15.5533884.118.326.246.236814.913.516.3
        Desmet (2005)2001BelgiumCross-section73082.367 ± 13.956——12.0—27.33712.08.816.1
        Davison (2003)2001–2002Canada41033.75 ± 3.260 ± 15.9581.555.610.210.737.13735.927.345.5
        Carreon (2008)2006USCross-section3754.4 ± 5.859 ± 1467——15.015.053.01621.313.631.9
    Both
        Sklar (1996)1995USCross-section1852.3860.5 ± 16.5596———36.42225.917.836.11518.011.027.1
        Unruh (2006)b1995–1998USCHOICE incident819090.2557.8 ± 14.8532712113.311.315.716117.715.420.3
        DMMS (1998)a1996–1997USUSRDS incident103539170.1659 ± 165328>29——>433107.97.18.81854.74.15.4
        Jadoul (2006)2002–2004Intl.DOPPS II prev.32012782————————217117.016.317.610788.48.08.9
    Benzodiazepines
        Winkelmayer (2007)c1996–1997USUSRDS incident103536300.1658.5 ± 15.6542971.010.017.348.640811.210.312.3
        Manley (2004)2003USDCI cross-section200104743.73 ± 4.060.2 ± 15.65245>26.6——>40.127652625.627.3
        Manley (2000)1999USCross-section22382.83 ± 2.859.5 ± 165321.0——28.03213.49.718.4
        Fukuhara (2006)2002–2004Intl.DOPPS II prev.>300512286917.016.018.0
    2002–2004JapanDOPPS II prev.591584————————30819.417.621.4
        Bailey (2007)1999Intl.DOPPS I prev.30749245.27 ± 5.658.9 ± 14.5581772.213.819.531.074115.014.116.1
    2002–2004Intl.DOPPS II prev.32077605.19 ± 5.661.7 ± 14.458977.016.324.932.5153620.219.321.1
    • HT, hypertension; CVD, cerebrovascular disease; PVD, peripheral vascular disease; DB, diabetes; Intl., international; prev., prevalent.

    • ↵a 1919 peritoneal dialysis patients.

    • ↵b 228 peritoneal dialysis patients.

    • ↵c 1558 peritoneal dialysis patients.

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    Table 3.

    Adverse events associated with opioid and benzodiazepine use

    Risk of OutcomeStudy
    With OpioidsWith Benzodiazepines
    Poor sleep quality1.55 (P < 0.0001)a1.59 (P < 0.0001)aElder (2008)
    1.22 (95% CI: 0.88 to 1.69)a1.67 (95% CI: 1.15 to 2.44)aUnruh (2006)
    Sexual dysfunction (pleasure)—1.26 (P = 0.0078)aBailie (2007)
    Sexual dysfunction (arousal)—1.24 (P = 0.0134)aBailie (2007)
    Hip fracture—1.0 (0.5 to 2.0)cWinkelmayer (2007)
    1.55 (P < 0.05)1.19 (P = 0.03)Jadoul (2006)
    Any fracture1.67 (0.01<P ≤ 0.05)1.31 (P = 0.03)Jadoul (2006)
    Falls3.7 (P < 0.001)a,b—Desmet (2005)
    Hospitalization—1.0 (0.9 to 1.1)Fukuhara (2006)
    Mortality—1.27 (1.01 to 1.59, P < 0.04)Fukuhara (2006)
    1.15 (1.02 to 1.31)bWinkelmayer (2007)
    • ↵a Odds ratios.

    • ↵b Unadjusted odds ratio.

    • ↵c Hazard ratios (all others are relative risk values).

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Clinical Journal of the American Society of Nephrology: 6 (2)
Clinical Journal of the American Society of Nephrology
Vol. 6, Issue 2
1 Feb 2011
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Opioid and Benzodiazepine Use in End-Stage Renal Disease: A Systematic Review
Ahraaz Wyne, Raman Rai, Meaghan Cuerden, William F. Clark, Rita S. Suri
CJASN Feb 2011, 6 (2) 326-333; DOI: 10.2215/CJN.04770610

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Opioid and Benzodiazepine Use in End-Stage Renal Disease: A Systematic Review
Ahraaz Wyne, Raman Rai, Meaghan Cuerden, William F. Clark, Rita S. Suri
CJASN Feb 2011, 6 (2) 326-333; DOI: 10.2215/CJN.04770610
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