Results from a study of adults with kidney failure suggest that taking both short-acting benzodiazepines and opioids may put patients at an especially high risk of dying prematurely. The findings appear in an upcoming issue of CJASN.
Increasing use of opioids in recent years has led to rising numbers of deaths and hospitalizations due to overdoses. In light of this opioid epidemic, it is important to understand whether other medications interact with opioids to elevate risks for patients. A team led by Mara McAdams-DeMarco, Ph.D. (Johns Hopkins Medical Institutions) looked to see if such an interaction exists for benzodiazepines (also considered tranquilizers or sedatives), which are some of the most commonly prescribed medications in the United States.
The study included 69,368 US adults with kidney failure who initiated hemodialysis in 2013 or 2014. Many patients with kidney failure have physical and psychiatric conditions that are treated with benzodiazepines, and they are also 3-times more likely to be prescribed opioids than the general population. “We sought to quantify the synergistic impact of benzodiazepines and opioids on mortality among patients initiating hemodialysis,” said Dr. McAdams-DeMarco.
During a median follow-up of 16 months, 15,175 patients (30%) died. Medicare claims data revealed the following:
“The potential risks associated with short-acting benzodiazepines should always be weighed against their therapeutic benefit and patients undergoing hemodialysis who are currently undergoing treatment with short-acting benzodiazepines should consider other treatments when clinically appropriate,” the authors wrote. “Furthermore, providers caring for patients undergoing hemodialysis should be given the tools needed to implement a collaborative, team-based approach for deprescribing of short-acting benzodiazepines, particularly for patients who are likely to use opioids.”
An accompanying Patient Voice editorial provides the perspective of a woman who describes herself as a kidney patient, a chronic pain patient, and an allied healthcare provider. “I am encouraged to see the crisis of palliative care being addressed in the kidney population,” she wrote.