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

Joseph Chan, Anil Bajnath, Beth Fromkin, Debbie Haine, Rute Paixao, Dianne Sandy, Umair Rhandhawa, Fei Wang, Mauro Braun

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.




World J Nephrol Urol. 2014;3(3):113-117
doi: http://dx.doi.org/10.14740/wjnu169w


Keywords


Ketorolac; Acute kidney injury; NSAIDs

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World Journal of Nephrology and Urology, quarterly, ISSN 1927-1239 (print), 1927-1247 (online), published by Elmer Press Inc.                     
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