Ketorolac-Induced Acute Renal Failure and Hyperkalemia: Report of Three Cases

Haragsim, Lukas; Dalal, Rashid; Bagga, Harprabhjot; Bastani, Bahar

doi:10.1016/s0272-6386(12)80215-0

Cited by 34 publications

(20 citation statements)

References 4 publications

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“…Even in the group with AKI, the incidence of hyperkalemia was as low as 9%. The mechanism for which hyperkalemia occurs with Ketorolac use is through decreased potassium excretion through the inhibitory effects of Ketorolac on aldosterone [5]. Hyperkalemia from other etiologies could have contributed.…”

Section: Discussionmentioning

confidence: 99%

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Ketorolac Prescribing Practices in an Acute Care Hospital and the Incidence of Acute Renal Failure

Chan

2014

World J Nephrol Urol

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Background: Ketorolac has been documented to cause acute kidney injury (AKI) but current data suggest that it is safe for those who have low risk for renal dysfunction. In our facility, there have been cases of AKI in those treated with Ketorolac but the incidence is not known. This study describes the prescribing habits of Ketorolac in our facility and determines the incidence of AKI while on this therapy. Methods:Electronic medical records of patients who received Ketorolac were reviewed during the last 3 months of 2012. AKI was defined as an increase of serum creatinine of 0.3 mg/dL or greater and a decrease in estimated glomerular filtration rate (eGFR) to less than 60 mL/minute. Results:A total of 633 patient charts were reviewed and 341 patients met the inclusion criteria. The mean age was 45.7 years. Sixty-five percent of the patients were females and 35% were males. The most common diagnosis for prescribing Ketorolac was osteoarthrosis. Thirty milligram IV every 6 hours is the conventional prescribed dose. Of the patients 6.4% developed AKI during treatment with Ketorolac, 68% of those with AKI were 65 or older, 68% had hypertension, 41% were diabetic, 40% were concomitantly receiving either an angiotensin converting enzyme-inhibitor (ACE-I) or an angiotensin receptor blocker (ARB), 40% were also being given diuretics, 72% received Ketorolac during the time of AKI and 3.8% of all patients who received Ketorolac developed hyperkalemia while on treatment.Conclusions: AKI occurs more commonly than previously anticipated in Ketorolac treated patients even at average doses and short durations. Hypertension and diabetes are the two most common comorbidities in patients who developed AKI. Those who are greater than 65 years old may be at higher risk. Concomitant use of drugs that affect renal function, such as ACE-I, ARBs and diuretics, may increase the risk of AKI. Ketorolac prescribing in the acute care hospital should consider individual comorbidities, and use of other drugs that can increase kidney failure risk. Awareness of current renal function through diligent review of daily labs may help prevent administration of Ketorolac in those with impaired renal function. Medication alerts that notifying the ordering physician of the eGFR may help prevent inadvertent prescription in those with AKI or chronic kidney disease.

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Section: Discussionmentioning

confidence: 99%

“…Case reports of acute kidney injury (AKI) associated with Ketorolac have been published since then [1][2][3][4][5][6][7][8]. Concerns about other serious side effects such as bleeding diathesis, gastrointestinal complications and even death have been raised [9,10].…”

Section: Introductionmentioning

confidence: 99%

Ketorolac Prescribing Practices in an Acute Care Hospital and the Incidence of Acute Renal Failure

Chan

2014

World J Nephrol Urol

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“…Cases of GI ulceration or bleeding have been reported after a brief use of ketorolac [12,13]. Furthermore, there have been reports of death and renal failure requiring dialysis in otherwise healthy patients who received only 1 dose of ketorolac [14,15].…”

Section: Discussionmentioning

confidence: 99%

A double-blind prospective comparison of rofecoxib vs ketorolac in reducing postoperative pain after arthroscopic knee surgery

Kim

Sherman

Cuff

et al. 2005

Journal of Clinical Anesthesia

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“…Please notice that Rofecoxib (Vioxx) has not been included in Table 1 NSAIDs. [24][25][26][27][28][29][30] According to one study, up to 15% cases of AKI are caused by NSAIDs; in patients older than 65 years, the rate can be greater than 25%. 31 Renal PGs cause vasodilatation of afferent vessels and assist in maintaining normal GFR.…”

Section: Acute Kidney Injury Hemodynamically Mediated Injurymentioning

confidence: 99%