Outcome implications of benzodiazepine and opioid co- prescription in kidney transplant recipients

The outcomes of benzodiazepine and opioid co- prescription are not well- defined in transplant populations. We examined linked national transplant registry and pharmaceutical records to characterize benzodiazepine and opioid use in the years before and after transplant in large US cohort of kidney transplant recipients (2007- 2016; N = 98 620), and associations (adjusted hazard ratio, LCLaHRUCL) with death and graft failure. Among the cohort, 15.6% filled benzodiazepine prescriptions in the year before transplant, and 14.0% filled benzodiazepine prescriptions in the year after transplant (short- acting, 9.5%; long- acting, 3.3%; both 1.1%). Use of short- acting benzodiazepines in the year before transplant was associated with a 22% increased risk of death in the year after transplant (aHR, 1.081.221.38), while use of all classes in the year after transplant was associated with increased risk of death from >1 to 5 years (aHR: short- acting 1.291.391.48; long- acting 1.121.251.40; both 1.461.742.07). Recipients who used benzodiazepines were also more likely to fill opioid prescriptions. Recipients who filled both classes of benzodiazepine and the highest level of opioids had a 2.9- fold increased risk of death compared to recipients who did not use either. Co- prescription of benzodiazepines and opioids in kidney transplant recipients is associated with increased mortality. Ongoing research is needed to understand mechanisms of risk relationships.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/162821/2/ctr14005.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/162821/1/ctr14005_am.pd

Factors Associated with Frailty and Prefrailty among 3365 ALIVE Study Person-Visits^a.

<p>Abbreviations : HAART, highly active antiretroviral therapy; VL, HIV viral load; UD, undetectable, <50 HIV RNA copies/ml; Hazardous alcohol use, score of ≥8 on the AUDIT; Depressive symptoms, score of ≥21 on the CES-D.</p><p>– Not included in final model/not significant in adjusted analyses.</p>a<p>Data are given as unadjusted and adjusted odds ratios (95% confidence interval).</p>b<p>Adjusted for age, gender, race, education, marital status, prescription drug abuse, depressive symptoms, # comorbid conditions and HIV status.</p>c<p>Adjusted for age, gender, race, education, marital status, prescription drug abuse, depressive symptoms, and # comorbid conditions.</p>d<p>Reflect characteristics within the previous 6 months.</p>e<p>Reflect characteristics within the prior year.</p>f<p>Diabetes, Hypertension, Cerebrovascular accident, Cardiovascular disease, Renal disease, Chronic obstructive pulmonary disease, Cancer, Obesity, Liver disease.</p

Frailty, HIV Infection, and Mortality in an Aging Cohort of Injection Drug Users

<div><h3>Background</h3><p>Frailty is associated with morbidity and premature mortality among elderly HIV-uninfected adults, but the determinants and consequences of frailty in HIV-infected populations remain unclear. We evaluated the correlates of frailty, and the impact of frailty on mortality in a cohort of aging injection drug users (IDUs).</p> <h3>Methods</h3><p>Frailty was assessed using standard criteria among HIV-infected and uninfected IDUs in 6-month intervals from 2005 to 2008. Generalized linear mixed-model analyses assessed correlates of frailty. Cox proportional hazards models estimated risk for all-cause mortality.</p> <h3>Results</h3><p>Of 1230 participants at baseline, the median age was 48 years and 29% were HIV-infected; the frailty prevalence was 12.3%. In multivariable analysis of 3,365 frailty measures, HIV-infected IDUs had an increased likelihood of frailty (OR, 1.66; 95% CI, 1.24–2.21) compared to HIV-uninfected IDUs; the association was strongest (OR, 2.37; 95% CI, 1.62–3.48) among HIV-infected IDUs with advanced HIV disease (CD4<350 cells/mm3 and detectable HIV RNA). No significant association was seen with less advanced disease. Sociodemographic factors, comorbidity, depressive symptoms, and prescription drug abuse were also independently associated with frailty. Mortality risk was increased with frailty alone (HR 2.63, 95% CI, 1.23–5.66), HIV infection alone (HR 3.29, 95% CI, 1.85–5.88), and being both HIV-infected and frail (HR, 7.06; 95%CI 3.49–14.3).</p> <h3>Conclusion</h3><p>Frailty was strongly associated with advanced HIV disease, but IDUs with well-controlled HIV had a similar prevalence to HIV-uninfected IDUs. Frailty was independently associated with mortality, with a marked increase in mortality risk for IDUs with both frailty and HIV infection.</p> </div

Survival by Frailty and HIV Status in the ALIVE cohort.

<p>Kaplan Meier Survival Curve Estimates for 1230 ALIVE Participants from July 2005 to December 2008. Frail- participants had a frailty score of 0–2; Frail+ participants had a frailty score of 3–5.</p

Characteristics of 1230 ALIVE Participants at 3365 Study Visits, by HIV Status^a.

<p>Abbreviations: HAART, highly active antiretroviral therapy; IQR, interquartile range; y, years; Hazardous alcohol use, score of ≥8 on the AUDIT; Depressive symptoms, score of ≥21 on the CES-D.</p>a<p>Data are no. (%) of participants, unless otherwise indicated.</p>b<p>Reflect characteristics within the previous 6 months.</p>c<p>Reflect characteristics within the prior year.</p>d<p>Diabetes, Hypertension, Cerebrovascular accident, Cardiovascular disease, Renal disease, Chronic obstructive pulmonary disease, Cancer, Obesity, Liver disease.</p

Outcome implications of benzodiazepine and opioid co‐prescription in kidney transplant recipients

The outcomes of benzodiazepine and opioid co- prescription are not well- defined in transplant populations. We examined linked national transplant registry and pharmaceutical records to characterize benzodiazepine and opioid use in the years before and after transplant in large US cohort of kidney transplant recipients (2007- 2016; N = 98 620), and associations (adjusted hazard ratio, LCLaHRUCL) with death and graft failure. Among the cohort, 15.6% filled benzodiazepine prescriptions in the year before transplant, and 14.0% filled benzodiazepine prescriptions in the year after transplant (short- acting, 9.5%; long- acting, 3.3%; both 1.1%). Use of short- acting benzodiazepines in the year before transplant was associated with a 22% increased risk of death in the year after transplant (aHR, 1.081.221.38), while use of all classes in the year after transplant was associated with increased risk of death from >1 to 5 years (aHR: short- acting 1.291.391.48; long- acting 1.121.251.40; both 1.461.742.07). Recipients who used benzodiazepines were also more likely to fill opioid prescriptions. Recipients who filled both classes of benzodiazepine and the highest level of opioids had a 2.9- fold increased risk of death compared to recipients who did not use either. Co- prescription of benzodiazepines and opioids in kidney transplant recipients is associated with increased mortality. Ongoing research is needed to understand mechanisms of risk relationships.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/162821/2/ctr14005.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/162821/1/ctr14005_am.pd