Altered Mental Status and Falls When Gabapentinoid and Other Psychoactive Medications Are Coprescribed to Patients Receiving Dialysis

A group of researchers including Rasheeda K. Hall, MD, conducted an observational cohort study to determine whether coprescription of gabapentinoids and other psychoactive potentially inappropriate medications (PPIMs) is associated with altered mental status (AMS) and falls among patients with kidney disease. The study also considered whether such associations are modified by frailty. 

The cohort comprised adults in the US Renal Data System receiving dialysis and having an active gabapentinoid prescription but no other PPIM prescriptions in the prior 6 months. The primary exposure was PPIM coprescribing, defined as prescription of a gabapentinoid medication and at least one other PPIM. The study outcome was acute-care visits for AMS and injurious falls.

The researchers used Prentice-Williams-Petersen Gap Time models to estimate the association between coprescription of PPIMs and each of the 2 outcomes, with adjustment for demographics, comorbidities, and frailty (as determined by a validated frailty index [FI]). Each of the models used tested for interaction between PPIM coprescribing and frailty.

PPIM coprescribing was found to be associated with an increased risk of both AMS (hazard ratio [HR], 1.66; 95% CI, 1.44-1.92) and falls (HR, 1.55; 95% CI, 1.36-1.77). Frailty significantly altered the effect coprescribing PPIMs had on the risk of AMS (P interaction=0.01) but did not demonstrate such an alteration with fall risk.

Among those with low frailty (FI=0.15), the HR for AMS with PPIM coprescribing was 2.14 (95% CI, 1.69-2.71). For those with severe frailty (FI=0.34), the HR for AMS with PPIM coprescribing was 1.64 (95% CI, 1.42-1.89). Patients who were coprescribed PPIMs and also had severe frailty (FI=0.34) had a higher risk for both AMS (HR, 3.22; 95% CI, 2.55-4.06) and falls (HR, 2.77; 95% CI, 2.27-3.38) compared with patients without frailty or PPIM coprescribing.

The authors concluded that, “Compared with gabapentinoid prescriptions alone, PPIM coprescribing was associated with an increased risk of AMS and falls. Clinicians should consider these risks when coprescribing PPIMs to patients receiving dialysis.”

Source: American Journal of Kidney Diseases