Opioid and Benzodiazepine Use in End-Stage Renal Disease

Abstract

SummaryBackground and objectives Chronic pain and psychiatric disorders are common in dialysis patients, but the extent to which opioids and benzodiazepines are used is unclear. We conducted a systematic review to determine the: (1) prevalence of opioid and benzodiazepine use among dialysis patients; (2) reasons for use; (3) effectiveness of symptom control; and (4) incidence of adverse events.Design, setting, participants, & measurements Two authors reviewed all relevant citations in MEDLINE/ EMBASE/CINAHL/BIOSIS Previews/Cochrane and hand-searched bibliographies. Studies after 1990 reporting prevalence estimates for opioid and/or benzodiazepine use in Ն50 dialysis patients were included. ResultsWe identified 15 studies from 12 countries over 1995 to 2006. Sample size ranged from 75 to 12,782. Prevalence of opioid and benzodiazepine use was variable, ranging from 5 to 36% (95% CI, 4.1 to 45.5%; n ϭ 10) and 8 to 26% (95% CI, 7.1 to 27.3%; n ϭ 9), respectively. Prevalence was positively correlated with years on dialysis. Five studies reported on the same cohorts but gave different prevalence estimates. One study verified medication use through patient interviews. Reasons for use were reported in one study. Effectiveness of pain control varied from 17 to 38%, and 72 to 84% of patients with significant pain had no analgesia (n ϭ 2). No study rigorously examined for adverse events. ConclusionsThe prevalence of opioid and benzodiazepine use in dialysis patients is highly variable between centers. Further information is needed regarding the appropriateness of these prescriptions, adequacy of symptom control, and incidence of adverse effects in this population.

The Psychological Impact of Hemodialysis on Patients with Chronic Renal Failure

“…Benzodiazepines (BZD), such as diazepam, alprazolam, and lorazepam, have been successfully used to relieve acute episodes of panic and anxiety. In addition, BZD are also widely prescribed for HD patients with insomnia (Wyne et al, 2011). In recent years, the use of non-BZD drugs such as zolpidem, zopiclone, and zaleplon for insomnia patients has rapidly increased.…”

Pain in Hemodialysis Patients

“…Bu duruma ek olarak hasta bireylere bakım verenlerin ağrı ve tedavisi konusunda bilgi eksikliğinin olması ve analjezik kullanımından çekinmeleri hastaların ağrı yaşamasına neden olan faktörler olarak karşımıza çıkmaktadır. Hastaların da analjeziklerin yan etkilerinden çekindikleri özel-likle opioid ilaçların bağımlılık yapması düşüncesini yoğunlukla yaşandıkları belirtilmektedir (38). Yapılan bu çalışmaya bakıl-dığında, tüm ağrı yaşayan bireylerin analjezik kullanmadığı; ilaç kullanan hastaların %62 oranında olduğu görülmekte ve bu durum literatürdeki sonuçları desteklemektedir.…”

“…Yapılan bir çalışmada; hastaların %17-38'inin efektif bir ağrı kontrolü sağladığı, ciddi ağrı yaşayan hastaların ise %84'ünün ağrı kesici almadan başetmeyi denediği görülmektedir (38). Bu çalışmada da hastaların yalnızca %62'sinin analjejik kullanımını tercih ettikleri saptanmıştır.…”

Geriatric Assessment, Falls and Rehabilitation in Patients Starting or Established on Peritoneal Dialysis

“…Arthritis affecting the hands or shoulders or pain from peripheral neuropathy may limit the use of assistive devices such as walkers or rolators, and therefore should be addressed. The altered metabolism of many drugs used in pain control make treatment protocols challenging and the reader is encouraged to read further on the topic (35)(36)(37)(38)(39).…”