Perioperative Ketorolac Use: A Potential Risk Factor for Renal Dysfunction After Live-Donor Nephrectomy

Takahashi, Kazuhiro; Patel, Anita; Nagai, Shunji; Safwan, Mohamed; Putchakayala, Krishna; Kane, William J.; Malinzak, Lauren; Denny, Jason E; Yoshida, Atsushi; Kim, Dean Y.

doi:10.12659/aot.904762

Cited by 9 publications

(9 citation statements)

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“…Many transplant centers use ketorolac for non-opioid pain management in donors [ 23 - 25 ]; however, before these studies, there was no level 1 data to support its widespread usage. This study does contradict Takahashi et al who found lower GFR and urinary alb/Cr ratio at one year following ketorolac use [ 22 ].…”

Section: Discussioncontrasting

confidence: 99%

“…While albuminuria (timed albumin excretion rate or albumin-to-creatinine ratio) is a better measure of renal damage according to the 2012 KDIGO CKD guidelines, proteinuria was the only consistent data available [ 21 ]. We focused on renal function as the primary endpoint; but, a larger multicenter study could expand to focus on longer follow-up after discharge examining quality of life and narcotic use [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

“…data available [21]. We focused on renal function as the primary endpoint; but, a larger multicenter study could expand to focus on longer follow-up after discharge examining quality of life and narcotic use [22].…”

mentioning

confidence: 99%

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One-Year Post Hoc Analysis of Renal Function for Live Kidney Donors That Were Enrolled in an Enhanced Recovery After Surgery Pathway With Ketorolac

Campsen¹,

Zhang²,

Presson³

et al. 2020

Cureus

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Background and Objective Opioid exposure is a concern after live donation for kidney transplants (LDKT). We previously theorized that an enhanced recovery after surgery (ERAS) pathway for LDKT will reduce perioperative narcotic use. The aim of this post hoc analysis of merged data from two ERAS trials was to review the one-year follow-up to determine if the exposure to ketorolac versus placebo had any significant impact on long-term kidney function after LDKT. Methods One-year post hoc analysis of merged data from two ERAS LDKT, prospective, double-blind, randomized clinical trials were combined involving a total of 72 patients undergoing nephrectomy for LDKT. Kidney functions of both the ERAS groups' versus placebo were compared prospectively and blinded at one year using estimated glomerular filtration rate (eGFR) and total protein (TP) in the urine in compliance with United Network for Organ Sharing (UNOS) live donor requirements. Results There was no significant difference in postoperative eGFR at one year between ERAS and placebo groups. TP urine at one-year post-operative was significantly lower in the ERAS cohort by 4.7 mg/dl (95% CI 0.48 ~ 8.82, p = 0.025). Conclusions The ERAS groups' exposure to ketorolac did not negatively affect kidney function at one year after LDKT.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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One-Year Post Hoc Analysis of Renal Function for Live Kidney Donors That Were Enrolled in an Enhanced Recovery After Surgery Pathway With Ketorolac

Campsen¹,

Zhang²,

Presson³

et al. 2020

Cureus

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“…The effect of NSAIDs on the postoperative renal function in our study is consistent with the effects observed in previous nephrectomy investigations [ 13 , 14 , 19 ]. However, a study by Takahashi et al, which examined patients undergoing live-donor nephrectomy, suggested that NSAIDs may be a risk factor for postoperative renal dysfunction [ 15 ]. A possible explanation for this discrepancy may lie in the percentage of patients who underwent partial nephrectomy in our study (80%), given that all patients in the study by Takahashi et al underwent radical resection [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…A few previous investigations have shown no association between the use of ketorolac and renal dysfunction [ 13 , 14 ]. However, a prior study showed that the use of ketorolac was a potential risk factor for long-term renal dysfunction in kidney donors [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

Comparison of Postoperative Renal Function between Non-Steroidal Anti-Inflammatory Drug and Opioids for Patient-Controlled Analgesia after Laparoscopic Nephrectomy: A Retrospective Cohort Study

Han

Jeon

et al. 2020

JCM

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Non-steroidal anti-inflammatory drugs (NSAIDs) can be used as opioid alternatives for patient-controlled analgesia (PCA). However, their use after nephrectomy has raised concerns regarding possible nephrotoxicity. This study compared postoperative renal function and postoperative outcomes between patients using NSAID and patients using opioids for PCA in nephrectomy. In this retrospective observational study, records were reviewed for 913 patients who underwent laparoscopic or robot-assisted laparoscopic nephrectomy from 2015 to 2017. After propensity score matching, 247 patients per group were analyzed. Glomerular filtration rate (GFR) percentages (postoperative value divided by preoperative value), blood urea nitrogen (BUN)/creatinine ratios, and serum creatinine percentages were compared at 2 weeks, 6 months, and 1 year after surgery between users of NSAID and users of opioids for PCA. Additionally, postoperative complication rates, postoperative acute kidney injury (AKI) incidences, postoperative pain scores, and lengths of hospital stay were compared between groups. Postoperative GFR percentages, BUN/creatinine ratios, and serum creatinine percentages were similar between the two groups. There were no significant differences in the rates of postoperative complications, incidences of AKI, and pain scores at 30 min, 6 h, 48 h, or 7 days postoperatively. The length of hospital stay was significantly shorter in the NSAID group than in the opioid group. This study showed no association between the use of NSAID for PCA after laparoscopic nephrectomy and the incidence of postoperative renal dysfunction.

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Comparison between ketorolac- and fentanyl-based patient-controlled analgesia for acute kidney injury after robot-assisted radical prostatectomy: a retrospective propensity score-matched analysis

et al. 2023

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Perioperative Ketorolac Use: A Potential Risk Factor for Renal Dysfunction After Live-Donor Nephrectomy

Cited by 9 publications

References 0 publications

One-Year Post Hoc Analysis of Renal Function for Live Kidney Donors That Were Enrolled in an Enhanced Recovery After Surgery Pathway With Ketorolac

One-Year Post Hoc Analysis of Renal Function for Live Kidney Donors That Were Enrolled in an Enhanced Recovery After Surgery Pathway With Ketorolac

Comparison of Postoperative Renal Function between Non-Steroidal Anti-Inflammatory Drug and Opioids for Patient-Controlled Analgesia after Laparoscopic Nephrectomy: A Retrospective Cohort Study

Comparison between ketorolac- and fentanyl-based patient-controlled analgesia for acute kidney injury after robot-assisted radical prostatectomy: a retrospective propensity score-matched analysis

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