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CHICAGO -- Prescribing of opioids to dialysis patients is linked to an increased mortality risk over 2 years, as well as increased risks of dialysis discontinuation and hospitalization, researchers reported here.

Patients prescribed opioids either short-term (less than 90 days) or long-term had a higher mortality risk than those not prescribed opioids -- 4% higher for those with short-term prescriptions and 27% higher for those with longer-term scripts, , of the National Institute of Diabetes and Digestive and Kidney Diseases, in Bethesda, Md., and colleagues noted in their poster presentation at the . Both groups also had higher risks of hospitalization and dialysis discontinuation.

Pain is a particularly important symptom for end-stage renal disease (ESRD) patients, the authors noted. "Of patients treated with hemodialysis, 50% report pain and 83% rate it moderate to severe; however, the pain perception of dialysis patients may differ between subpopulations."

Aggressive pain treatment has long been recommended for dialysis patients, although advise caution when prescribing opioids to any patients. However, little is known about how pain treatment affects their outcomes.

To study the problem, the investigators examined data on opioid prescriptions from the U.S. Renal Data System for 2006 to 2010; they then looked at opioid prescriptions for more than 153,000 dialysis patients in the 2010 cohort and associations with mortality, hospitalization, and dialysis discontinuation over the period from Jan. 1, 2011 to Dec. 31, 2012.

Inclusion criteria included continuous dialysis treatment for at least 1 year and full coverage under Medicare Parts A, B, and D. The researchers controlled for demographics, ethnicity, comorbidity, and residence.

The patient group was evenly split between males and females; about one-fifth were ages 20-44, around 40% were ages 45-64, and another 40% or so were 65 and above. Most patients were either white or African American, with slightly fewer African Americans than whites.

Outcome measures included all-cause death, discontinuation of dialysis, and first hospitalization.

From 2006 to 2010, more than 60% of dialysis patients had a prescription filled for an opioid medication (63.1% in 2016 and 64.0% in 2010), the researchers found. About 20% of patients studied were prescribed at least 3 months of opioids annually. Chronic opioid prescription was independently associated with female gender, white race, younger age, greater vintage, dual Medicare/Medicaid status, cancer diagnosis, hospitalizations, and not living in a large metropolitan area.

The most common opioids prescribed included those with hydrocodone (11.7% of prescriptions), oxycodone (5.4%), and tramadol (2.5%).

The increased mortality risk applied to all opioid drugs, including tramadol, a class IV agent; the one exception was codeine, although codeine was associated with increased hospitalization. Chronic prescription of hydrocodone, oxycodone, propoxyphene, morphine, hydromorphone, and fentanyl were all significantly associated with increased risk of dialysis discontinuation.

"While causal relationships cannot be inferred, and opioid prescription may be an illness marker, efforts to treat pain effectively in dialysis patients with less toxic interventions deserve consideration," the authors concluded.

, a senior research analyst at Social and Scientific Systems in Silver Spring, Md., noted that even though opioids are not the first drug usually suggested for pain in ESRD patients, "we do not know the situation" with regard to renal function and other factors. "We try to control for comorbidity, but there may be other factors we can't account for."

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