Occurrence of benzodiazepines and nonbenzodiazepines usage among newly-onset of peritoneal dialysis versus hemodialysis patients

The use of central nervous system depressants, including benzodiazepines (BZDs) and nonbenzodiazepine hypnotics (Z-drugs), is increasingly observed in chronic dialysis patients. Hemodialysis (HD) and peritoneal dialysis (PD) patients differ in physiological stress and neuropsychiatric profiles, yet both groups are exposed to medications such as BZDs and Z-drugs, whose adverse effects including sedation, cognitive impairment, and increased mortality, may further compound the psychological vulnerability and survival risks inherent to these dialysis populations. However, comparative patterns of their use across dialysis modalities remain insufficiently understood. In this retrospective study, we enrolled patients newly diagnosed with end-stage renal disease who met the criteria for catastrophic illness in the National Health Insurance Research Database (NHIRD) between January 1, 2007, and December 31, 2017. PD and HD patients were propensity score–matched in a 1:3 ratio. Kaplan–Meier methods were used to estimate the new-onset BZDs and Z-drugs usage rate and to construct survival curves. Cox proportional hazards regression models were applied to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for new-onset BZDs and Z-drugs use between PD and HD groups. Follow-up ended no later than December 31, 2020. The study compares BZDs and Z-drugs usage between PD and HD patients across three different time intervals: within 90 days, within 270 days, and after 270 days. Initially, PD patients had a significantly lower incidence of BZDs usage [aHR 0.858 (95% CI 0.740–0.993)]. However, this advantage diminished over time and reversed after 270 days, while PD patients showing higher rates of BZDs usage [aHR 1.446 (95% CI 1.286–1.627)]. In contrast, Z-drugs usage rate showed no statistically significant difference between the two groups across all intervals. When compared to patients on HD, those on PD exhibit a gradual rise in BZDs usage over time, which raises concerns about concurrent psychological symptoms. Further research is required to explore the neuropsychological mechanisms underlying psychological problems in patients on long-term PD.