Opioid Safety and Concomitant Benzodiazepine Use in End-Stage Renal Disease Patients

Table 4

Proposed classification of opioids based on risk for hospitalization due to opioid overdose in ESRD patients on hemodialysis.

Original classification	Drug	Hospitalization within 30 days	Hospitalization within 60 days	Hospitalization within 90 days	Proposed classification^^
		OR (95% CI)	OR (95% CI)	OR (95% CI)
Safe	Hydromorphone	2.5 (2.2–2.8)	1.9 (1.7–2.1)	1.7 (1.5–1.9)	Moderate risk
	Fentanyl	3.0 (2.7–3.6)	2.8 (2.5–3.1)	2.7 (2.4–3.0)	High risk
	Methadone	6.0 (5.2–6.9)	5.3 (4.7–6.1)	4.8 (4.2–5.4)	Very high risk
Caution	Buprenorphine	5.4 (2.7–10.5)	3.9 (2.1–7.2)	4.3 (2.5–7.2)	Very high risk
	Hydrocodone	1.9 (1.8–2.0)	1.7 (1.6–1.8)	1.7 (1.6–1.8)	Low risk
	Oxycodone	3.1 (2.9–3.3)	2.7 (2.6–2.9)	2.6 (2.4–2.7)	High risk
	Oxymorphone	4.6 (3.0–7.1)	4.3 (2.9–6.2)	3.4 (2.4–4.9)	Very high risk
Unsafe	Meperidine	3.5 (1.7–7.1)	2.6 (1.4–4.9)	2.6 (1.5–4.6)	High risk
	Morphine	6.9 (6.2–7.6)	5.8 (5.2–6.4)	5.2 (4.7–5.7)	Very high risk
	Codeine	2.0 (0.8–4.8)	2.0 (1.0–4.3)	1.8 (0.9–3.6)	N/A
	Tapentadol	1.8 (0.2–12.8)	1.7 (0.4–6.9)	2.0 (0.6–6.3)	N/A
	Propoxyphene	0.8 (0.6–1.0)	0.8 (0.6–0.9)	0.7 (0.6–0.9)	N/A
	Benzodiazepine	1.5 (1.4–1.7)	1.5 (1.4–1.7)	1.5 (1.4–1.6)

OR, odds ratio of hospitalization due to opioid overdose; CI, confidence interval. Multivariable logistic regression models included all opioids and benzodiazepines. ^{^}Based on risk stratification using OR at 30 days: low risk, OR 1–1.9; moderate risk, OR 2–2.9; high risk, OR 3–3.9; very high risk, OR 4 and above. Not statistically significant, not statistically significant and wide CI due to sparse data, and drug no longer available in market.