Integrated Approach to Pain and Opioid Use in Hemodialysis Patients


The Research Need

Pain is a common problem in Medicare end-stage renal disease (ESRD) hemodialysis patients. The rate of chronic opioid prescriptions in ESRD hemodialysis patients, approximately 20 percent, is higher than the rate in Medicare comparison populations.

ESRD hemodialysis patients are an ideal population in which to launch and monitor interventions because of their long-term participation in monitored treatment and the availability of data resources. To date, many interventions, both behavioral and medical, have not been tried in this population or have not been rigorously evaluated by randomized controlled trials. These interventions could reduce the rate of opioid prescription and opioid use and could address related issues, such as depression, anxiety, and pain.

About the Program

The Hemodialysis Opioid Prescription Effort (HOPE) consortium will develop an intervention to address the problems of pain and opioid use in U.S. hemodialysis populations. The consortium will initiate multipronged pain treatment tailored to each patient, without opioids, and using buprenorphine and other novel agents to reduce dependence on opioids in affected patients.

Analyses will consider comorbid illnesses, such as diabetes and mental health disorders, and social determinants of health, such as socioeconomic status, social isolation, social support, residential factors, and perception of racial discrimination. The goal is to identify novel risk factors for pain and opioid use in this population.

End points will be chronic opioid prescription rates, prescription drug doses, pain control, patient satisfaction with care, perception of quality of life, hospitalization rates, and mortality rates. The consortium may use electronic health records to capture real-time risk factor and outcomes data by leveraging and expanding a pilot set of more than 200 standardized data elements that the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Chronic Kidney Disease eCare Plan Working Group identified and prioritized for comprehensive chronic kidney disease care.

Program Details

To date, through the Helping to End Addiction Long-term® Initiative, or NIH HEAL Initiative®, NIH has contributed $28.4 million to fund this program, through eight clinical centers and one scientific and data research center.

Clinical Centers

  • Hennepin Healthcare Research Institute – Minnesota
  • Massachusetts General Hospital – Massachusetts
  • New York University – New York
  • University of Illinois, Chicago – Illinois
  • University of Pittsburgh – Pennsylvania
  • University of Washington – Washington
  • Vanderbilt University – Tennessee
  • Yale University – Connecticut

Scientific and Data Research Center

  • University of Pennsylvania – Pennsylvania

Funded Projects

Creating a multi-level intervention to reduce stigma for buprenorphine use for individuals with End Stage Kidney Disease and Chronic Pain
Sep 29, 2020
University of Illinois at Chicago Hemodialysis Opioid Prescription Effort (HOPE) Clinical Center
Sep 29, 2020
Video-Telecare Collaborative Pain Management to Improve Function and Reduce Opioid Risk in Patients with End Stage Renal Disease Receiving Hemodialysis
Mar 19, 2020
Randomized ESRD Trial COmparing CBT alone VERsus with buprenorphine (RECOVER)
Mar 19, 2020
UPENN Scientific and Data Research Center for the HOPE Consortium to Reduce Pain and Opioid Use in Hemodialysis
Mar 19, 2020