Acute kidney injury is common with intravenous abuse of extended‐release oral oxymorphone and delayed renal recovery rates are associated with increased KDIGO staging. Issue 10 (24th September 2018)

• Record Type: Journal Article
• Authors: Bonnecaze, Alex K; Wilson, Matthew W; Dharod, Ajay; Fletcher, Alison; Miller, Peter John
• Is Part Of: Nephrology. Volume 23:Issue 10(2018)
• Page Start: 921
• Page End: 926
• Publication Date: 2018-09-24
• Subjects: acute renal failure -- extended‐release oxymorphone -- intravenous drug abuse -- opana -- thrombotic microangiopathy; Nephrology -- Periodicals; Kidneys -- Diseases -- Periodicals; Nephrologists -- Periodicals; 616.61; 616.61
• DOI: 10.1111/nep.13153
• Languages: English
• ISSNs: 1320-5358

Abstract

Summary at a Glance: This retrospective study analyzed the association between intravenous abuse of extended‐release oxymorphine and acute kidney injury. The prevalence of acute kidney injury was 47.8%. Individuals with established chronic kidney disease had a worse outcome. Although previously reported as an association, no cases of thrombotic microangiopathy were reported in this cohort. ABSTRACT: Aim: Prescription opioid abuse poses a serious problem in the United States, representing 615 per 100 000 deaths annually. Extended‐release oxymorphone (Opana‐ER) is an oral opioid pain medication that has recently been found to cause thrombotic microangiopathy when intravenously abused. In this retrospective study, we attempted to determine the prevalence and outcomes of acute kidney injury (AKI) among patients intravenously abusing extended‐release oral oxymorphone. Methods: A query of electronic medical records for 'drug abuse' at an academic medical centre during January 2012 to December 2015 was performed and yielded 2350 patients. Patients were further identified by documented intravenous abuse of extended‐release oxymorphone. Patients were stratified based on multiple renal indices and outcomes. Potential confounders were also identified. Results: One hundred and sixty‐five patients were found to have a documented history of intravenous abuse of extended‐release oral oxymorphone. Prevalence of AKI in this population was a 47.8%. KDIGO stage‐I patients consisted of 17.8% of patients with AKI, 40.5% were classified as KDIGO stage‐II AKI, and 41.8% were classified as KDIGO stage‐III AKI. Among patients with AKI, average age was found to be 37.5 years, 59.4% experienced renal recovery, 56.9% required intensive care unit admission, 13.9% progressed to end‐stage renal disease (ESRD), and 7.6% expired during admission. Conclusion: Clinicians should be educated to help recognize intravenous abuse of extended‐release oral oxymorphone and its associated effects. Our data suggests AKI is common in these patients; higher KDIGO staging appears to be associated with slower rates of renal recovery, increased comorbidities and progression to both CKD and ESRD.