Gabapentin, Concomitant Prescription of Opioids, and Benzodiazepines among Kidney Transplant Recipients

Abstract

Background Gabapentinoids, commonly used for treating neuropathic pain, may be misused and coprescribed with opioid and benzodiazepine, increasing the risk of mortality and dependency among kidney transplant recipients.Methods We identified adult kidney transplant recipients who enrolled in Medicare Part D in 2006-2017 using the United States Renal Data System/Medicare claims database. We characterized recipients' post-transplant concomitant prescription of gabapentinoids, opioids, and benzodiazepine stratified by transplant year and recipient factors (age, sex, race, and diabetes). We investigated whether concomitant prescriptions were associated with postkidney transplant mortality using Cox regression. Models incorporated inverse probability weighting to adjust for confounders.Results Among 63,359 eligible recipients, 13% of recipients filled at least one gabapentinoid prescription within 1 year after kidney transplant. The prevalence of gabapentinoid prescriptions increased by 70% over the study period (16% in 2017 versus 10% in 2006). Compared with nonusers, gabapentinoids users were more likely to have diabetes (55% versus 37%) and obesity (46% versus 34%). Of the 8509 recipients with gabapentinoid prescriptions, 45% were coprescribed opioids, 7% were coprescribed benzodiazepines, and 3% were coprescribed both opioids and benzodiazepines. Compared with no study prescriptions, gabapentinoid monotherapy (adjusted hazard ratio [aHR]51.25; 95% confidence interval [CI], 1.16 to 1.32) and combination therapy (gabapentinoids and opioids [aHR51.49; 95% CI, 1.39 to 1.60], gabapentinoids and benzodiazepines [aHR51.46; 95% CI, 1.03 to 2.08], and coprescribing all three [aHR51.88; 95% CI, 1.18 to 2.98]) were all associated with a higher risk of postkidney transplant mortality.Conclusions Gabapentinoid coprescription with both benzodiazepines and opioids among kidney transplant recipients increased over time. Kidney transplant recipients prescribed gabapentinoids had a higher risk of posttransplant mortality, and the risk was higher with opioids or benzodiazepine coprescription.

The Value of Pain Sensitivity Questionnaire in Predicting Postoperative Pain in Living Kidney Donors: A Prospective Observational Study

“… 4 In addition, kidney donation may be associated with long-term disease and pain. 12 , 13 Inadequate treatment of postoperative pain can reduce the patient’s ability to participate in rehabilitation plans, leading to poor postoperative outcomes, and delaying patient recovery and discharge time, reducing quality of life and satisfaction, increasing resource consumption and medical costs. PSQ is a non-invasive method for measuring pain sensitivity.…”

Balancing Risk and Uncertain Benefit in Pharmacotherapy for Pain in Kidney Transplant Recipients

“…In this issue of CJASN , Chen et al 5 present results of an observational study using national registry data from the United States Renal Data System (USRDS), demonstrating new evidence that gabapentinoids are associated with a higher risk of death among kidney transplant recipients. The authors identified adults who had a first-time kidney transplant between 2006 and 2017 and were enrolled in Medicare Part D and Medicare as the primary insurer at time of transplant.…”

“…10,11 In summary, the work of Chen et al using rigorous observational methods brings important attention to the allcause mortality risk of gabapentinoids, especially in combination with opioids and benzodiazepines, among kidney transplant recipients. 5 Future work building off these findings to explore mechanisms, mediators, and moderators is warranted. This study brings ever more urgency to developing effective nonpharmacologic pain treatment options and risky pharmacotherapy deimplementation strategies in this vulnerable population.…”