{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T05:21:42Z","timestamp":1789708902566,"version":"4.0.1"},"reference-count":47,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["CJASN"],"published-print":{"date-parts":[[2018,5]]},"abstract":"<jats:sec>\n                    <jats:title>Background and objectives<\/jats:title>\n                    <jats:p>Patients on hemodialysis frequently experience pain and may be particularly vulnerable to opioid-related complications. However, data evaluating the risks of opioid use in patients on hemodialysis are limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design, setting, participants, &amp; measurements<\/jats:title>\n                    <jats:p>Using the US Renal Data System, we conducted a cohort study evaluating the association between opioid use (modeled as a time-varying exposure and expressed in standardized oral morphine equivalents) and time to first emergency room visit or hospitalization for altered mental status, fall, and fracture among 140,899 Medicare-covered adults receiving hemodialysis in 2011. We evaluated risk according to average daily total opioid dose (&gt;60 mg, \u226460 mg, and per 60-mg dose increment) and specific agents (per 60-mg dose increment).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The median age was 61 years old, 52% were men, and 50% were white. Sixty-four percent received opioids, and 17% had an episode of altered mental status (15,658 events), fall (7646 events), or fracture (4151 events) in 2011. Opioid use was associated with risk for all outcomes in a dose-dependent manner: altered mental status (lower dose: hazard ratio, 1.28; 95% confidence interval, 1.23 to 1.34; higher dose: hazard ratio, 1.67; 95% confidence interval, 1.56 to 1.78; hazard ratio, 1.29 per 60 mg; 95% confidence interval, 1.26 to 1.33), fall (lower dose: hazard ratio, 1.28; 95% confidence interval, 1.21 to 1.36; higher dose: hazard ratio, 1.45; 95% confidence interval, 1.31 to 1.61; hazard ratio, 1.04 per 60 mg; 95% confidence interval, 1.03 to 1.05), and fracture (lower dose: hazard ratio, 1.44; 95% confidence interval, 1.33 to 1.56; higher dose: hazard ratio, 1.65; 95% confidence interval, 1.44 to 1.89; hazard ratio, 1.04 per 60 mg; 95% confidence interval, 1.04 to 1.05). All agents were associated with a significantly higher hazard of altered mental status, and several agents were associated with a significantly higher hazard of fall and fracture.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Opioids were associated with adverse outcomes in patients on hemodialysis, and this risk was present even at lower dosing and for agents that guidelines have recommended for use.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2215\/cjn.09910917","type":"journal-article","created":{"date-parts":[[2018,4,19]],"date-time":"2018-04-19T11:10:22Z","timestamp":1524136222000},"page":"746-753","source":"Crossref","is-referenced-by-count":78,"title":["Opioid Analgesics and Adverse Outcomes among Hemodialysis Patients"],"prefix":"10.2215","volume":"13","author":[{"given":"Julie H.","family":"Ishida","sequence":"first","affiliation":[{"name":"Medicine and"},{"name":"Division of Nephrology, San Francisco Veterans Affairs Medical Center, San Francisco, California; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles E.","family":"McCulloch","sequence":"additional","affiliation":[{"name":"Epidemiology and Biostatistics, University of California, San Francisco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael A.","family":"Steinman","sequence":"additional","affiliation":[{"name":"Division of Geriatrics, University of California, San Francisco and San Francisco Veterans Affairs Medical Center, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara A.","family":"Grimes","sequence":"additional","affiliation":[{"name":"Epidemiology and Biostatistics, University of California, San Francisco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6421-361X","authenticated-orcid":false,"given":"Kirsten L.","family":"Johansen","sequence":"additional","affiliation":[{"name":"Medicine and"},{"name":"Epidemiology and Biostatistics, University of California, San Francisco, California;"},{"name":"Division of Nephrology, San Francisco Veterans Affairs Medical Center, San Francisco, California; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2018,4,19]]},"reference":[{"key":"B1-20230816","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1053\/j.ackd.2006.10.001","article-title":"The prevalence of symptoms in end-stage renal disease: A systematic review.","volume":"14","author":"Murtagh","year":"2007","journal-title":"Adv Chronic Kidney 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