Opioid and benzodiazepine use in end-stage renal disease: a systematic review.
OBJECTIVE
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.


METHODS
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 ≥50 dialysis patients were included.


RESULTS
We 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=10) and 8 to 26% (95% CI, 7.1 to 27.3%; n=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=2). No study rigorously examined for adverse events.


CONCLUSIONS
The 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.
University of Western Ontario, London Kidney Clinical Research Unit, Room ELL-101 Victoria Hospital, 800 Commissioners Road East, London, Ontario N6A 4G5, Canada.
Ahraaz
A
Wyne
Raman
R
Rai
Meaghan
M
Cuerden
William F
WF
Clark
Rita S
RS
Suri
D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000009:adverse effects / Q000627:therapeutic use*; D002492:Central Nervous System Depressants / Q000009:adverse effects / Q000627:therapeutic use*; D004363:Drug Utilization; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications*; D001523:Mental Disorders / Q000188:drug therapy* / Q000209:etiology; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D010147:Pain Measurement; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
D000701:Analgesics, Opioid; D002492:Central Nervous System Depressants; D001569:Benzodiazepines