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

Abstract

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.

Ketorolac- and warfarin-induced renal toxicity: ultrastructural and biochemical study

“…These altered parameters were in accordance with several reports reflecting a disturbed kidney function (Aly et al, 2015;Hörl, 2010;Kim & Joo, 2007;Pelligand et al, 2015) More recently, Lucas et al (2018) reported that NSAIDs increase the risk of developing nephrotoxicity and acute tubular necrosis and they recommended that this condition be well evaluated. The authors concluded that NSAIDs, selective and non-selective, directly interfere with renal function due to prostaglandin inhibition, and suggested acute sodium retention, which is the main cause of the overfilling effect due to arterial hypertension and edema (Chana et al, 2014). This edema was clearly localized as severe vacuolation in the kidney tubules of co-administrated group, KT/WR, of the present work.…”

“…The major mechanisms for WR-induced renal toxicity were previously reported as glomerular hemorrhage and tubular dysfunction by obstruction due to RBC casts (Mendonca, Gupta, Valsan, & Tewari, 2017;Ozcan et al, 2012). Similar to Chana et al (2014) who revealed that KT induced acute kidney injury, another NSAID, diclofenac sodium, was found to induce the congestion in the blood vessels, the degeneration in nephrons, and the increase in the connective tissue in rat kidneys (Khoshvakhti et al, 2015). Thus, the combined treatment of KT and WR may be responsible for the accelerated progressive events of acute kidney injury obtained in the current study.…”

“…Ketorolac is considered a potent analgesic with moderate anti-inflammatory effects (Schwier & Tran, 2016), although it has certain harmful effects on vital body organs such as the liver, kidney, and gastrointestinal tract (Aly et al, 2015;Bally et al, 2017;Tomic et al, 2008). During the recent years, an increasing number of studies have been published concerning the nephrotoxic effects of NSAIDs and anticoagulants (Chana et al, 2014;Lanas & Chan, 2017;Ozcan et al, 2012;Sriuttha, Sirichanchuen, & Permsuwan, 2018). The present investigation was constructed to study the co-administrative effect of KT and WR on histological picture and some biochemical parameters of rat kidney.…”

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

“….033 Congestive heart failure 2 ( Direct correlation of ketorolac use and acute kidney injury has been described with mixed results in the literature. A recent retrospective review by Chan et al found that kidney injury with ketorolac was more common in patients 65 and older, had hypertension and/or diabetes [16]. Ying and colleagues found that preoperative NSAID administration in patients undergoing major orthopedic surgery was associated with AKI, as well as a linear relationship between dose and occurrence [17].…”

Analisis Kualitas Hidup pada Pasien Hemodialisis di Rumah Sakit Wilayah Cirebon

“…Menurut (I., 2011), setelah usia 40 tahun, Glomerular Filtration Rate (GFR) menurun sekitar 10 ml/menit sehingga pada usia 70 tahun GFR telah menurun sekitar 30 ml/menit. Penurunan fungsi ginjal pada penuaan ini bersifat irreversible (Chan et al, 2014). Proses penuaan juga diperparah oleh faktor klinis yang menjadi faktor resiko terjadinya penyakit gangguan ginjal.…”