@article{ref1,
title="Zolpidem versus trazodone initiation and the risk of fall-related fractures among  individuals receiving maintenance hemodialysis",
journal="Clinical journal of the American Society of Nephrology",
year="2020",
author="Assimon, Magdalene M. and Flythe, Jennifer E.",
volume="ePub",
number="ePub",
pages="ePub-ePub",
abstract="BACKGROUND AND OBJECTIVES: Zolpidem, a nonbenzodiazepine hypnotic, and trazodone, a  sedating antidepressant, are the most common medications used to treat insomnia in  the United States. Both drugs have side effect profiles (e.g., drowsiness,  dizziness, and cognitive and motor impairment) that can heighten the risk of falls  and fractures. Despite widespread zolpidem and trazodone use, little is known about  the comparative safety of these medications in patients receiving hemodialysis, a  vulnerable population with an exceedingly high fracture rate. DESIGN, SETTING,  PARTICIPANTS, & MEASUREMENTS: Using data from the United States Renal Data System  registry (2013-2016), we conducted a retrospective cohort study to investigate the  association between the initiation of zolpidem versus trazodone therapy and the  30-day risk of hospitalized fall-related fractures among Medicare-enrolled patients  receiving maintenance hemodialysis. We used an active comparator new-user design and  estimated 30-day inverse probability of treatment-weighted hazard ratios and risk  differences. We treated death as a competing event. <br><br>RESULTS: A total of 31,055  patients were included: 18,941 zolpidem initiators (61%) and 12,114 trazodone  initiators (39%). During the 30-day follow-up period, 101 fall-related fractures  occurred. Zolpidem versus trazodone initiation was associated with a higher risk of  hospitalized fall-related fracture (weighted hazard ratio, 1.71; 95% confidence  interval, 1.11 to 2.63; weighted risk difference, 0.17%; 95% confidence interval,  0.07% to 0.29%). This association was more pronounced among individuals prescribed  higher zolpidem doses (hazard ratio, 1.85; 95% confidence interval, 1.10 to 3.01;  and risk difference, 0.20%; 95% confidence interval, 0.04% to 0.38% for higher-dose  zolpidem versus trazodone; and hazard ratio, 1.60; 95% confidence interval, 1.01 to  2.55 and risk difference, 0.14%; 95% confidence interval, 0.03% to 0.27% for  lower-dose zolpidem versus trazodone). Sensitivity analyses using longer follow-up  durations yielded similar results. <br><br>CONCLUSIONS: Among individuals receiving  maintenance hemodialysis, zolpidem initiators had a higher risk of hospitalized  fall-related fracture compared with trazodone initiators. PODCAST: This article  contains a podcast at  https://www.asn-online.org/media/podcast/CJASN/2020_12_18_CJN10070620_final.mp3.<p /> <p>Language: en</p>",
language="en",
issn="1555-9041",
doi="10.2215/CJN.10070620",
url="http://dx.doi.org/10.2215/CJN.10070620"
}