Long-term opioid and gabapentinoid related harms in CKD

TY - JOUR

T1 - Long-term opioid and gabapentinoid related harms in CKD

AU - Grant, Christopher H.

AU - Livingstone, Shona

AU - Wang, Huan

AU - Barnett, Karen N.

AU - Mark, Patrick B.

AU - Colvin, Lesley A.

AU - Bell, Samira

PY - 2026/9/17

Y1 - 2026/9/17

N2 - Introduction Chronic pain affects over half of patients with chronic kidney disease (CKD). This study aimed to evaluate the association between new long-term opioids or gabapentinoids and the risk of death, hospitalisation and hip fractures in adults with CKD. Methods Design: Retrospective, time-updated, population-based cohort study. Setting: Community-setting, East of Scotland (n=953,542) using linked routinely collected data. Population: 30,674 adults with biochemically confirmed CKD (eGFR<60ml/min/1.73m2) without kidney failure from 2010–2023. Exposure(s): New, long-term cumulative opioids or gabapentinoids. Statistical analyses: Discrete time logistic regression modelling with generalized estimating equations and adjustment for relevant covariates and treatment allocation bias. Primary outcome: All-cause mortality. Results 30,674 adults with CKD entered the study. 21,440 patients without prevalent analgesic use were included in the primary and secondary analyses (median follow-up 4.3 years). Among 2,399 patients with at least one continuous 90-day episode of opioid prescriptions during follow-up, 1,159 died. The risk of death increased as continuous 90-day opioid stretches (reference zero) increased from one (absolute risk of death 0.4% [0.3 to 0.4]; OR 1.09 [1.06 to 1.12], p < 0.001) to six (absolute risk of death 0.6% [0.5 to 0.7]; OR 1.68 [1.41 to 2.00], p < 0.001). Long-term gabapentinoids were associated with a modest increase in death amongst males (OR 1.04 [1.00 to 1.08], p = 0.050), but not females (OR 1.02 [0.99 to 1.05], p = 0.201). Conclusions Long-term opioid use is associated with increased mortality and hospitalisation in adults with CKD independent of demographics, comorbidities and treatment allocation bias. These findings support prioritisation of safer pain management strategies in people with CKD.

AB - Introduction Chronic pain affects over half of patients with chronic kidney disease (CKD). This study aimed to evaluate the association between new long-term opioids or gabapentinoids and the risk of death, hospitalisation and hip fractures in adults with CKD. Methods Design: Retrospective, time-updated, population-based cohort study. Setting: Community-setting, East of Scotland (n=953,542) using linked routinely collected data. Population: 30,674 adults with biochemically confirmed CKD (eGFR<60ml/min/1.73m2) without kidney failure from 2010–2023. Exposure(s): New, long-term cumulative opioids or gabapentinoids. Statistical analyses: Discrete time logistic regression modelling with generalized estimating equations and adjustment for relevant covariates and treatment allocation bias. Primary outcome: All-cause mortality. Results 30,674 adults with CKD entered the study. 21,440 patients without prevalent analgesic use were included in the primary and secondary analyses (median follow-up 4.3 years). Among 2,399 patients with at least one continuous 90-day episode of opioid prescriptions during follow-up, 1,159 died. The risk of death increased as continuous 90-day opioid stretches (reference zero) increased from one (absolute risk of death 0.4% [0.3 to 0.4]; OR 1.09 [1.06 to 1.12], p < 0.001) to six (absolute risk of death 0.6% [0.5 to 0.7]; OR 1.68 [1.41 to 2.00], p < 0.001). Long-term gabapentinoids were associated with a modest increase in death amongst males (OR 1.04 [1.00 to 1.08], p = 0.050), but not females (OR 1.02 [0.99 to 1.05], p = 0.201). Conclusions Long-term opioid use is associated with increased mortality and hospitalisation in adults with CKD independent of demographics, comorbidities and treatment allocation bias. These findings support prioritisation of safer pain management strategies in people with CKD.

U2 - 10.1016/j.ekir.2026.107085

DO - 10.1016/j.ekir.2026.107085

M3 - Article

SN - 2468-0249

JO - Kidney International Reports

JF - Kidney International Reports

M1 - 107085

ER -