Identification of Risk Factors for Acute Kidney Injury from Intravenous Ketorolac in Geriatric Trauma Patients

Hall, Sarah; Mangram, Alicia; Barletta, Jeffrey F.

doi:10.1007/s00268-021-06320-z

Cited by 4 publications

(3 citation statements)

References 27 publications

(23 reference statements)

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“…Ketorolac (mean dose 42.3 mg) was the most commonly used preparation, and no effect size in the form of adjusted OR or relative risk was given as the incidence of kidney injury was only 0.12% [ 15 ]. However, the incidence of acute kidney injury as defined by Kidney Disease Improving Global Outcomes (KDIGO) criteria in the similar population who received ketorolac has been reported to be 2.5% [ 16 ], and thus many kidney injury events might have been left undetected in that study. In a study of younger patients undergoing resection of the gastrointestinal tract and hepatobiliary surgery, NSAIDs given during postoperative days 0 to 3 were not associated with acute kidney injury by postoperative day 7 as defined by KDIGO criteria with adjusted OR of 0.8 [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Association between perioperative non-steroidal anti-inflammatory drug use and cardiovascular complications after non-cardiac surgery in older adult patients

Komatsu,

Singleton,

Dinges

et al. 2024

JA Clin Rep

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Background We investigated in older adult non-cardiac surgical patients whether receipt of perioperative non-steroidal anti-inflammatory drugs (NSAIDs) is associated with increased incidence of postoperative cardiovascular complications. Methods We retrospectively extracted the information for patients with age ≥ 65 years who had inpatient non-cardiac surgery with a duration of ≥ 1 h from the American College of Surgeons-National Surgical Quality Improvement Program registry data acquired at the University of Washington Medical Center. We compared patients who received NSAIDs perioperatively to those who did not receive NSAIDs, on the two composite outcomes: (1) the incidence of postoperative cardiovascular complications within 30 days of the surgery, and (2) the incidence of combined postoperative gastrointestinal and renal complications, and length of postoperative hospital stay. We used separate multivariable logistic regression models to analyze the two composite outcomes and a Poisson regression model for the length of hospital stay. Results The receipt of perioperative NSAIDs was not associated with postoperative cardiovascular complications (estimated odds ratio (OR), 1.78; 95% confidence interval (CI), 0.97 to 3.25; P = 0.06), combined renal and gastrointestinal complications (estimated OR, 1.30; 95% CI, 0.53 to 3.20; P = 0.57), and length of postoperative hospital stay in days (incidence rate ratio, 1.06; 95% CI, 0.93 to 1.21; P = 0.39). Conclusions In older adult non-cardiac surgical patients, receipt of perioperative NSAIDs was not associated with increased incidences of postoperative cardiovascular complications, and renal and gastrointestinal complications within 30 days after surgery, or length of postoperative hospital stay.

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Section: Discussionmentioning

confidence: 99%

Association between perioperative non-steroidal anti-inflammatory drug use and cardiovascular complications after non-cardiac surgery in older adult patients

Komatsu,

Singleton,

Dinges

et al. 2024

JA Clin Rep

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“…52,60 Notably, a retrospective cohort of 316 trauma patients over 60 years old and receiving ketorolac reported a 2.5% incidence of acute kidney injury. 61 Multivariate analysis revealed loop diuretics and the total number of comorbidities as predictors of AKI, but not age. Since adverse side effects are more likely at higher dosages and longer durations of use, 52,62 guidelines recommend avoiding chronic use of NSAIDs in geriatric patients except for those meeting certain criteria: failure of other therapies, favorable risk/benefit profile, ongoing monitoring of therapy, and concurrent proton pump inhibitor administration.…”

Section: Concerns Beyond Analgesiamentioning

confidence: 97%

Nonopioid Analgesics for the Perioperative Geriatric Patient: A Narrative Review

Wilson

Bridges

et al. 2022

Anesthesia &Amp; Analgesia

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Management of acute perioperative pain in the geriatric patient can be challenging as the physiologic and pharmacokinetic changes associated with aging may predispose older patients to opioid-related side effects. Furthermore, elderly adults are more susceptible to postoperative delirium and postoperative cognitive dysfunction, which may be exacerbated by both poorly controlled postoperative pain and commonly used pain medications. This narrative review summarizes the literature published in the past 10 years for several nonopioid analgesics commonly prescribed to the geriatric patient in the perioperative period. Nonopioid analgesics are broken down as follows: medications prescribed throughout the perioperative period (acetaminophen and nonsteroidal antiinflammatory drugs), medications limited to the acute perioperative setting (N-methyl-D-aspartate receptor antagonists, dexmedetomidine, dexamethasone, and local anesthetics), and medications to be used with caution in the geriatric patient population (gabapentinoids and muscle relaxants). Our search identified 1757 citations, but only 33 specifically focused on geriatric analgesia. Of these, only 21 were randomized clinical trials‚ and 1 was a systematic review. While guidance in tailoring pain regimens that focus on the use of nonopioid medications in the geriatric patient is lacking, we summarize the current literature and highlight that some nonopioid medications may extend benefits to the geriatric patient beyond analgesia. (Anesth Analg 2022;135:290-306) GLOSSARY AChEI = acetylcholinesterase inhibitor; AGS = American Geriatric Society; ALT = alanine aminotransferase; ANS = autonomic nervous system; AV = atrioventricular; CBF = cerebral blood flow; CINAHL = Cumulative Index to Nursing and Allied Health Literature; C max = maximum plasma concentration; CNS = central nervous system; COX = cyclooxygenase; CVA = cerebrovascular accident; ED = effective dose; ER = extended release; FDA = US Food and Drug Administration; GABA = gamma-aminobutyric acid; GFR = glomerular filtration rate; GI = gastrointestinal; ICU = intensive care unit; IM = intramuscular; IR = immediate release; IV = intravenous; LOS = length of stay; MA = meta-analysis; MAOIs = monoamine oxidase inhibitors; MeSH = Medical Subject Heading; MI = myocardial ischemia; NAPQI = N-acetyl-p-benzoquinone imine; NMDA = N-methyl-d-aspartate; NO = nitric oxide; NSAIDs = nonsteroidal anti-inflammatory drugs; PGE2 = prostaglandin E2; POCD = postoperative cognitive dysfunction; POD = postoperative day; PONV = postoperative nausea and vomiting; PPI = proton pump inhibitor; PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses; RBF = renal blood flow; RCT = randomized controlled trial; SA = sinoatrial; SAH = subarachnoid hemorrhage; SE = side effects; T 1/2 = half-life; TKA = total knee arthroplasty; V d = volume of distribution Chronic Pain Medicine E NArrAtiVe reView Article

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“…AKI in trauma patient is complicated and its cause is diverse, renal ischemia being the commonest etiology. Even though different researches have established that hypotension, rhabdomyolysis, venous thromboembolism, acidosis, shock and infections have been participating factors (4) . AKI has been demonstrated to be accompanied by adverse outcomes among trauma cases and development of AKI is closely accompanied by increased mortality and length of stay (LOS) (5) .…”

Section: Introductionmentioning

confidence: 99%

Acute Kidney Injury Among Severe Trauma Patients in ICU

Salama¹,

Abdel-Megeed²,

Ahmed³

et al. 2022

The Egyptian Journal of Hospital Medicine

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Background: Trauma is a major public health burble and is associated with a high mortality rate. Acute kidney injury (AKI) has been demonstrated to be accompanied by adverse outcomes among trauma cases and development of AKI is closely accompanied by increased mortality and length of stay (LOS). Objective: To determine the incidence and the associated risk factors of AKI in severe trauma patients and its outcome in the emergency intensive care unit (ICU). Patients and Methods: This was a prospective study conducted on 104 patients with severe trauma at Mansoura University Hospital. Entire cases were classified into 2 groups; AKI cases; patients who met the RIFLE criteria for AKI and non-AKI cases. Entire cases were subjected resuscitation followed by physical examination and laboratory investigations. In addition, trauma scores were assessed. Results: Forty-six percent of patients developed AKI by RIFLE criteria. There were significant differences among AKI and non-AKI in the context of sepsis, shock, coagulopathy and rhabdomyolysis. There were statistical significance serum creatinine (S.cr) levels at emergency room (ER), S.cr peak level at ICU, PH value at ICU, comorbidities, sepsis, shock, LOS, glomerular filtration rate (GFR) at ER and GFR with peak S.cr as independent predictors of AKI among sever trauma patients. Conclusion: Risk factors of trauma-associated AKI included rhabdomyolysis, coagulopathy, nephrotoxic drugs, shock and sepsis. Development of AKI after severe trauma is closely accompanied by increased mortality and LOS. Early detection of AKI and management of risk factors of AKI can improve the outcome.

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Identification of Risk Factors for Acute Kidney Injury from Intravenous Ketorolac in Geriatric Trauma Patients

Cited by 4 publications

References 27 publications

Association between perioperative non-steroidal anti-inflammatory drug use and cardiovascular complications after non-cardiac surgery in older adult patients

Association between perioperative non-steroidal anti-inflammatory drug use and cardiovascular complications after non-cardiac surgery in older adult patients

Nonopioid Analgesics for the Perioperative Geriatric Patient: A Narrative Review

Acute Kidney Injury Among Severe Trauma Patients in ICU

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