Prevalence and Factors Associated with Opioid Prescription in Swiss Chronic Hemodialysis Patients

Pain is a common symptom in patients on chronic hemodialysis (HD) but the prevalence of opioid prescriptions in this population has been poorly studied outside the United States. This study assesses the prevalence of opioid prescription in two Swiss dialysis centers. Prescriptions and clinical characteristics were retrospectively retrieved from the medical records of patients on HD for at least six months, treated at Lausanne University Hospital (academic center, AC), and the private center Clinique Cecil (PC) for the study. A total of 117 patients were included; 29.1% received at least one opioid prescription during the study period. Significantly more patients received an opioid prescription in the AC (39.1%) than in the PC (14.6%, p = 0.004). Univariate logistic regression analysis showed that center (Odds Ratio (OR) 3.76; Confidence Interval (CI) 1.48-9.6; p = 0.006), neuropathic pain (OR 2.99; CI 1.28-6.98; p = 0.011), benzodiazepine prescription (OR 2.72; CI 1.14-6.46; p = 0.024), polyneuropathy (OR 2.71; CI 1.14-6.46; p = 0.024) and amputation (OR 4.23; CI 1.1-16.1; p = 0.034) were associated with opioid prescription. The center was the only independent predictive factor in the multivariate analysis. Our results show that opioids are regularly prescribed to Swiss dialysis patients, although important differences exist between centers. The latter finding might suggest that opioid prescribing is more related to the prescriber than to the patient's condition, but larger-scale studies are necessary to confirm this.