{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T05:21:40Z","timestamp":1789708900625,"version":"4.0.1"},"reference-count":40,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","funder":[{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"crossref","award":["R01 DK100446"],"award-info":[{"award-number":["R01 DK100446"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"crossref","award":["R01 DK115534"],"award-info":[{"award-number":["R01 DK115534"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"crossref","award":["T32DK7732-24"],"award-info":[{"award-number":["T32DK7732-24"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["CJASN"],"published-print":{"date-parts":[[2019,11]]},"abstract":"<jats:sec>\n                    <jats:title>Background and objectives<\/jats:title>\n                    <jats:p>Most opioids undergo kidney excretion. The goal of this study was to evaluate opioid-associated risks of death and hospitalization across the range of eGFR.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design, setting, participants, &amp; measurements<\/jats:title>\n                    <jats:p>The study population included adult primary care patients in Geisinger Health (Danville, PA) between 2008 and 2017. People receiving their first opioid prescription were propensity matched to people receiving NSAIDS (and, in sensitivity analysis, gabapentinoids) and the risk of death and hospitalization were compared, classifying opioid medication exposure as time-varying daily oral morphine milligram equivalents (MMEs) across time-varying eGFR.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The propensity-matched cohort included 46,246 patients prescribed either opioids or NSAIDs between 2008 and 2017 (mean [SD] age, 54 [16] years; 56% female; 3% of black race). Prescriptions for 1\u201359 and \u226560 MMEs were associated with higher risk of death (HR, 1.70; 95% CI, 1.41 to 2.05 for 1\u201359 MMEs; HR, 2.25; 95% CI, 1.82 to 2.79 for \u226560 MMEs) and hospitalization (HR, 1.38; 95% CI, 1.30 to 1.46 for 1\u201359 MMEs; HR, 1.68; 95% CI, 1.56 to 1.81 for \u226560 MMEs) compared with NSAID prescriptions, when evaluated at eGFR 80 ml\/min per 1.73 m\n                      <jats:sup>2<\/jats:sup>\n                      . The relative risk of death associated with \u226560 MMEs was higher at lower GFR (\n                      <jats:italic toggle=\"yes\">e.g.<\/jats:italic>\n                      , eGFR, 40 ml\/min per 1.73 m\n                      <jats:sup>2<\/jats:sup>\n                      ; HR, 3.94; 95% CI, 2.70 to 5.75;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      for interaction, 0.01). When gabapentinoids were used as the comparison medication, only \u226560 MMEs were significantly associated with higher risk of death (HR, 2.72; 95% CI, 1.71 to 4.34), although both 1\u201359 and \u226560 MMEs were associated with risk of hospitalization (HR, 1.22; 95% CI, 1.04 to 1.43 for 1\u201359 MMEs; HR, 1.54; 95% CI, 1.28 to 1.86 for \u226560 MMEs).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The receipt of prescription opioids was associated with a higher risk of death and hospitalization compared with other pain medications, particularly with higher doses and at lower eGFR.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2215\/cjn.00440119","type":"journal-article","created":{"date-parts":[[2019,10,3]],"date-time":"2019-10-03T15:25:15Z","timestamp":1570116315000},"page":"1581-1589","source":"Crossref","is-referenced-by-count":27,"title":["Associations of Opioid Prescriptions with Death and Hospitalization across the Spectrum of Estimated GFR"],"prefix":"10.2215","volume":"14","author":[{"given":"Tessa K.","family":"Novick","sequence":"first","affiliation":[{"name":"Division of Nephrology, Department of Internal Medicine, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aditya","family":"Surapaneni","sequence":"additional","affiliation":[{"name":"Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jung-Im","family":"Shin","sequence":"additional","affiliation":[{"name":"Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland;"},{"name":"Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G. Caleb","family":"Alexander","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lesley A.","family":"Inker","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, Massachusetts; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric A.","family":"Wright","sequence":"additional","affiliation":[{"name":"Center for Pharmacy Innovation and Outcomes,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8114-7447","authenticated-orcid":false,"given":"Alex R.","family":"Chang","sequence":"additional","affiliation":[{"name":"Geisinger Health, Danville, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Morgan E.","family":"Grams","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Internal Medicine, and"},{"name":"Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland;"},{"name":"Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2019,10,3]]},"reference":[{"key":"B1-20230813","doi-asserted-by":"crossref","first-page":"870","DOI":"10.1097\/MLR.0b013e3182a95d86","article-title":"Ambulatory diagnosis and treatment of nonmalignant pain in the United States, 2000-2010","volume":"51","author":"Daubresse","year":"2013","journal-title":"Med Care"},{"key":"B2-20230813","doi-asserted-by":"crossref","first-page":"293","DOI":"10.7326\/M17-0865","article-title":"Prescription opioid use, misuse, and use disorders in U.S. Adults: 2015 National survey on 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