Gender differences in use of prescription narcotic medications among living kidney donors

Lentine, Krista L.; Lam, Ngan N.; Garg, Amit X.; Xiao, Huiling; Leander, Sheila; Brennan, Daniel C.; Taler, Sandra J.; Axelrod, David A.; Segev, Dorry L.

doi:10.1111/ctr.12599

Cited by 10 publications

(5 citation statements)

References 55 publications

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“…We also quantified the months that antidepressants were dispensed to patients in the 12‐month period before transplant, among those with at least 12 months of pre‐transplant pharmacy records, as a metric of the intensity of exposure . To account for concomitant use of multiple agents, the metric for any antidepressant exposure aggregated fill days from different classes even if prescription dates were overlapping . Separate analyses quantified antidepressant use in the year before wait‐listing and in the first year after transplantation.…”

Section: Methodsmentioning

confidence: 99%

Antidepressant medication use before and after kidney transplant: implications for outcomes - a retrospective study

et al. 2017

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We examined a novel database wherein national US transplant registry identifiers were linked to records from a large pharmaceutical claims warehouse (2008-2015) to characterize antidepressant use before and after kidney transplantation, and associations [adjusted hazard ratio (aHR) 95% CI] with death and graft failure. Among 72 054 recipients, 12.6% filled antidepressant medications in the year before transplant, and use was more common among women and patients who were white, unemployed, and had limited functional status. Pre-transplant antidepressant use was associated with 39% higher 1-year mortality (aHR 1.39, 95% CI 1.18-1.64) and 15% higher all-cause graft loss risk (aHR 1.15, 95% CI 1.02-1.30). More than 50% of patients who filled antidepressants pre-transplant continued fill post-transplant. Antidepressant use in the first year after transplant was associated with twofold higher risk of death (aHR 1.94, 95% CI 1.60-2.35), 38% higher risk of death-censored graft failure, and 61% higher risk of all-cause graft failure in the subsequent year. Pre-listing antidepressant use was also associated with increased mortality, but transplantation conferred a survival benefit regardless of prelisting antidepressant use status. While associations may in part reflect underlying behaviors or comorbidities, kidney transplant candidates and recipients treated with antidepressant medications should be monitored and supported to reduce the risk of adverse outcomes.

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Section: Methodsmentioning

confidence: 99%

Antidepressant medication use before and after kidney transplant: implications for outcomes - a retrospective study

et al. 2017

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“…Proportion of days covered is defined as [days of treatment supplied over an observation window]/[days of observation], where the observation windows were defined as the periods of identified insurance benefits for an individual during an observation period. 13,14 …”

Section: Methodsmentioning

confidence: 99%

Diabetes Mellitus in Living Pancreas Donors

et al. 2017

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Background Living donor pancreas transplant is a potential treatment for diabetic patients with end-organ complications. While early surgical risks of donation have been reported, long-term medical outcomes in living pancreas donors are not known. Methods We integrated national Scientific Registry of Transplant Recipients data (1987–2015) with records from a nationwide pharmacy claims warehouse (2005–2015) to examine prescriptions for diabetic medications and supplies as a measure of post-donation diabetes mellitus. To compare outcomes in controls with baseline good health, we matched living pancreas donors to living kidney donors (1:3) by demographic traits and year of donation. Results Among 73 pancreas donors in the study period, 45 were identified in the pharmacy database: 62% women, 84% white, and 80% relatives of the recipient. Over a mean postdonation follow-up period of 16.3 years, 26.7% of pancreas donors filled prescriptions for diabetes treatments, compared with 5.9% of kidney donors (odds ratio [OR] 4.13, 95% confidence interval [CI] 1.91–8.93; P = 0.0003). Use of insulin (11.1% vs. 0%) and oral agents (20.0% vs. 5.9%; OR 4.50, 95% CI 2.09–9.68; P = 0.0001) was also higher in pancreas donors. Conclusion Diabetes is more common after living pancreas donation than after living kidney donation, supporting clinical consequences from reduced endocrine reserve.

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“…Recognition of these deficiencies, and the vital need to address them, prompted a growing body of research over the past decade that has helped advance understanding of donor risks (7). The study methodologies include construction of multicenter cohorts (8,9), integration of national donor registries with other data sources to acquire longer-term information for a broader spectrum of outcomes (10)(11)(12)(13)(14)(15)(16)(17)(18)(19), and assembly of healthy nondonor controls for estimation of donation-attributable risks (20)(21)(22)(23)(24)(25). The resulting evidence suggests small donation-related increases in the risk of kidney failure that have affected policy requirements and guidelines for the informed consent and care of living donors (26,27).…”

Section: Introductionmentioning

confidence: 99%

Risks of Living Kidney Donation

Lentine¹,

Lam²,

Segev³

2019

CJASN

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120

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In the past decade, there have been increasing efforts to better define and quantify the short-and long-term risks of living kidney donation. Recent studies have expanded upon the previous literature by focusing on outcomes that are important to potential and previous donors, applying unique databases and/or registries to follow large cohorts of donors for longer periods of time, and comparing outcomes with healthy nondonor controls to estimate attributable risks of donation. Leading outcomes important to living kidney donors include kidney health, surgical risks, and psychosocial effects of donation. Recent data support that living donors may experience a small increased risk of severe CKD and ESKD compared with healthy nondonors. For most donors, the 15-year risk of kidney failure is <1%, but for certain populations, such as young, black men, this risk may be higher. New risk prediction tools that combine the effects of demographic and health factors, and innovations in genetic risk markers are improving kidney risk stratification. Minor perioperative complications occur in 10%-20% of donor nephrectomy cases, but major complications occur in <3%, and the risk of perioperative death is <0.03%. Generally, living kidney donors have similar or improved psychosocial outcomes, such as quality of life, after donation compared with before donation and compared with nondonors. Although the donation process should be financially neutral, living kidney donors may experience out-of-pocket expenses and lost wages that may or may not be completely covered through regional or national reimbursement programs, and may face difficulties arranging subsequent life and health insurance. Living kidney donors should be fully informed of the perioperative and long-term risks before making their decision to donate. Follow-up care allows for preventative care measures to mitigate risk and ongoing surveillance and reporting of donor outcomes to inform prior and future living kidney donors.

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Gender differences in use of prescription narcotic medications among living kidney donors

Cited by 10 publications

References 55 publications

Antidepressant medication use before and after kidney transplant: implications for outcomes - a retrospective study

Antidepressant medication use before and after kidney transplant: implications for outcomes - a retrospective study

Diabetes Mellitus in Living Pancreas Donors

Risks of Living Kidney Donation

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