Table 1.
Select baseline characteristics of patients receiving hemodialysis in the United States who initiated zolpidem or trazodone
| Unweighted | Weighted | |||||
|---|---|---|---|---|---|---|
| Characteristic | Zolpidem, n=18,941 | Trazodone, n=12,114 | Std Diffa | Zolpidem, n=18,964 | Trazodone, n=12,100 | Std Diffa |
| Age, yr, mean±SD | 59±14 | 61±15 | 0.09 | 60±15 | 60±15 | 0.00 |
| Female, n (%) | 8611 (45) | 5740 (47) | 0.04 | 8794 (46) | 5620 (46) | 0.00 |
| Race, n (%) | ||||||
| Black | 7415 (39) | 4573 (38) | 0.03 | 7291 (38) | 4655 (38) | 0.00 |
| White | 10,420 (55) | 6962 (57) | 0.05 | 10,642 (56) | 6789 (56) | 0.00 |
| Other | 1106 (6) | 579 (5) | 0.05 | 1031 (5) | 656 (5) | 0.00 |
| Hispanic, n (%) | 4024 (21) | 1930 (16) | 0.15 | 3639 (19) | 2322 (19) | 0.00 |
| Low income subsidy, n (%) | 14,700 (78) | 9460 (78) | 0.01 | 14,768 (78) | 9427 (78) | 0.00 |
| Dialysis vintage, yr, median (quartile 1, quartile 3) | 3.6 (1.7, 6.7) | 3.4 (1.6, 6.3) | 0.06 | 3.5 (1.6, 6.5) | 3.5 (1.6, 6.5) | 0.00 |
| Cause of dialysis-dependent kidney failure, n (%) | ||||||
| Diabetes | 8589 (45) | 5821 (48) | 0.05 | 8814 (46) | 5637 (47) | 0.00 |
| Hypertension | 5746 (30) | 3382 (28) | 0.05 | 5567 (29) | 3544 (29) | 0.00 |
| Glomerular disease | 2220 (12) | 1287 (11) | 0.04 | 2135 (11) | 1365 (11) | 0.00 |
| Other | 2386 (13) | 1624 (13) | 0.02 | 2448 (13) | 1554 (13) | 0.00 |
| Anxiety, n (%) | 4019 (21) | 3559 (29) | 0.19 | 4654 (25) | 2984 (25) | 0.00 |
| Depression, n (%) | 4738 (25) | 4592 (38) | 0.28 | 5748 (30) | 3664 (30) | 0.00 |
| Arrhythmia, n (%) | 6370 (34) | 4262 (35) | 0.03 | 6506 (34) | 4146 (34) | 0.00 |
| Conduction disorder, n (%) | 2080 (11) | 1615 (13) | 0.07 | 2280 (12) | 1468 (12) | 0.00 |
| Heart failure, n (%) | 8907 (47) | 6128 (51) | 0.07 | 9204 (49) | 5882 (49) | 0.00 |
| Hypertension, n (%) | 17,076 (90) | 11,146 (92) | 0.07 | 17,243 (91) | 11,003 (91) | 0.00 |
| Ischemic heart disease, n (%) | 9137 (48) | 6102 (50) | 0.04 | 9302 (49) | 5940 (49) | 0.00 |
| Peripheral artery disease, n (%) | 6652 (35) | 4640 (38) | 0.07 | 6894 (36) | 4398 (36) | 0.00 |
| Stroke, n (%) | 4371 (23) | 3341 (28) | 0.10 | 4727 (25) | 3020 (25) | 0.00 |
| Diabetes, n (%) | 13,029 (67) | 8649 (71) | 0.06 | 13,249 (70) | 8456 (70) | 0.00 |
| Number of frailty indicators, n (%)b | ||||||
| 0 indicators | 9496 (50) | 5137 (42) | 0.16 | 8902 (47) | 5665 (47) | 0.00 |
| 1 indicator | 4153 (22) | 2528 (21) | 0.03 | 4091 (22) | 2622 (22) | 0.00 |
| 2 indicators | 2083 (11) | 1478 (129) | 0.03 | 2189 (12) | 1401 (12) | 0.00 |
| 3 indicators | 1350 (7) | 1048 (9) | 0.06 | 1459 (8) | 927 (8) | 0.00 |
| 4 indicators | 883 (5) | 885 (7) | 0.11 | 1078 (6) | 690 (6) | 0.00 |
| ≥5 indicators | 976 (5) | 1038 (9) | 0.14 | 1245 (7) | 795 (7) | 0.00 |
| Use of ≥1 other CNS-active med, n (%)c | 9022 (48) | 6301 (52) | 0.09 | 9429 (50) | 6040 (50) | 0.00 |
| Number of baseline hospital admissions, median (quartile 1, quartile 3) | 1 (0, 2) | 1 (0, 2) | 0.09 | 1 (0, 2) | 1 (0, 2) | 0.00 |
| SNF admission during baseline, n (%) | 2211 (12) | 2341 (19) | 0.21 | 2785 (15) | 1775 (15) | 0.00 |
| Psychotherapy visit during baseline, n (%) | 994 (5) | 1178 (10) | 0.17 | 1358 (7) | 857 (7) | 0.00 |
All covariates were measured during the 180-d baseline period. The weighted cohort is the pseudo-population generated by inverse probability of treatment weighting. Supplemental Table 7 displays the full list of baseline characteristics considered in our analyses stratified by study medication. All variables in Supplemental Table 7 were used to estimate propensity scores and inverse probability of treatment weights. CNS, central nervous system; SNF, skilled nursing facility; med, medication; std diff, standardized difference.
A std diff >0.10 represents meaningful imbalance between groups (28).
A total of 14 validated frailty indicators associated with mobility impairment and falls were considered. Frailty indicators included abnormal gait, abnormal loss of weight or underweight, cachexia, debility, difficulty walking, failure to thrive, fall history, malaise or fatigue, muscular wasting or disease atrophy, muscle weakness, pressure ulcers, senility, using durable medical equipment (cane, walker, bath equipment, or commode), and using nursing or health care services (27).
CNS-active medications included antidepressants (selective serotonin reuptake inhibitors, serotonin-NE reuptake inhibitors, tricyclic antidepressants), antipsychotics, benzodiazepines, antiepileptics, and opioids. These medications are associated with a heightened risk of fall according to the 2019 Beers Criteria (37).