Urinary protein profiles in ketorolac-associated acute kidney injury in patients undergoing orthopedic day surgery

Mariano, Filippo; Cogno, C; Giaretta, Fulvia; Deambrosis, Ilaria; Pozza, Simona; Berardino, Maurizio; Massazza, Giuseppe; Biancone, Luigi

doi:10.2147/ijnrd.s137102

Cited by 5 publications

(4 citation statements)

References 17 publications

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“…22 Mariano et al found in a study of 1397 patients undergoing orthopedic surgery and receiving ketorolac that only .29% developed severe AKI. 23 Similar to our study, Yang et al performed a nonrandomized study of development of AKI in 619 rib fracture patients receiving ketorolac or other forms of pain management. Their study used the KDIGO definition for AKI and found no difference in AKI comparing K and NK patients.…”

Section: Discussionsupporting

confidence: 65%

Ketorolac Use for Pain Management in Trauma Patients With Rib Fractures Does not Increase of Acute Kidney Injury or Incidence of Bleeding

Torabi

Kaban

Lewis

et al. 2020

The American Surgeon™

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Introduction Ketorolac is useful in acute pain management to avoid opiate-related complications; however, some surgeons fear associated acute kidney injury (AKI) and bleeding despite a paucity of literature on ketorolac use in trauma patients. We hypothesized that our institution's use of intravenous ketorolac for rib fracture pain management did not increase the incidence of bleeding or AKI. Methods Rib fracture patients aged 15 years and above admitted between January 2016-June 2018 were identified in our trauma registry along with frequency of bleeding events. AKI was defined as ≥ 1.5x increase in serum creatinine from baseline measured on the second day of admission (after 24 hours of resuscitation) or an increase of ≥ .3 mg/dL over a 48-hour period. Patients receiving ketorolac were compared to patients with no ketorolac use. Results Two cohorts of 199 control and 205 ketorolac patients were found to be similar in age, gender, admission systolic blood pressure (SBP), injury severity score, intravenous radiocontrast received, and transfusion requirements. Analysis revealed no difference in frequency of AKI using both definitions (8% vs. 7.3%, P = .79) and (19.6% vs. 15.1%, P = .24), respectively, or bleeding events (2.5% vs. 0%, P = .03). Logistic regression demonstrated that ketorolac use was not an independent predictor for AKI but age and admission SBP < 90 were. Conclusion Use of ketorolac in this cohort of trauma patients with rib fractures did not increase the incidence of AKI or bleeding events.

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Section: Discussionsupporting

confidence: 65%

Ketorolac Use for Pain Management in Trauma Patients With Rib Fractures Does not Increase of Acute Kidney Injury or Incidence of Bleeding

Torabi

Kaban

Lewis

et al. 2020

The American Surgeon™

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“…In these cases, ketorolac was administered parenterally, for 1‐2 days at recommended doses. All patients recovered their renal function …”

Section: Discussionmentioning

confidence: 94%

Chronic kidney disease and acute kidney injury in arthroplasty patients over 65 years of age

Nikkinen

Nieminen

Alahuhta

et al. 2019

Acta Anaesthesiol Scand

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Background:The purpose of this study was to evaluate the prevalence of chronic kidney disease (CKD) and the incidence of perioperative acute kidney injury (AKI) in primary arthroplasty patients over 65 years of age. Risk factors, perioperative events and the outcome of surgery were evaluated.Methods: This retrospective, hospital register-based study consists of patients operated in 2014 in the area of Oulu, Finland. The estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration formula. The incidence of AKI was evaluated based on the serum creatinine criteria of the KDIGO (Kidney Disease, Improving Global Outcomes) classification. Results:Of the 807 patients, 60.8% had mildly decreased (60-89 ml/min/1.73 m 2 ) and 13.5% moderately to severely decreased eGFR (<60 ml/min/1.73 m 2 ) preoperatively. Only 33.9% of patients with an eGFR < 60 ml/min/1.73 m 2 had a diagnosis of a kidney disease. In emergencies, 46.9% of patients with an eGFR < 60 ml/ min/1.73 m 2 were deceased at the 12-month follow-up point. The measurement of postoperative sCr was not complete (477/807) and was allocated to emergencies and older patient with more comorbidities. Of those whose postoperative sCr was available, 14 (2.9%) fulfilled AKI criteria. Most of the AKI cases had a decrease in eGFR preoperatively, a diagnosed kidney disease or diabetes mellitus.Conclusions: Impairment of kidney function was common and was related to mortality in emergency arthroplasties. Measurements of postoperative sCr were allocated to high risk patients. Preoperative kidney function, kidney disease and diabetes mellitus were important determinants for perioperative AKI.

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“…This is further supported by a statistically significant difference in serum sodium (136.0 vs. 138.0 mEq/L). Dehydration has been reported as a risk factor for AKI in other populations exposed to ketorolac, including healthy children and adults being treated for pain postoperatively 28,29 . While cases of AKI do not appear to be directly related to ketorolac dose alone, they are associated with preadmission factors such as hydration.…”

Section: Discussionmentioning

confidence: 99%

The Risk of Kidney Injury in Patients With Sickle Cell Disease Treated With Ketorolac for Acute Pain

Harris,

Oni,

Donado

et al. 2024

Journal of Pediatric Hematology/Oncology

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Ketorolac, a nonsteroidal anti-inflammatory drug, is used in combination with opioids to manage vaso-occlusive episodes (VOEs). The relationship between ketorolac use and kidney injury in pediatric patients with sickle cell disease (SCD) remains incompletely understood. We hypothesize that ketorolac is associated with acute kidney injury (AKI) in patients with SCD presenting with pain. All nonsurgical hospitalizations for VOEs treated with ketorolac between January 2014 and December 2022 were included. We used optimal matching methodology to identify control admissions (2:1 ratio) and used nonparametric tests to compare ketorolac administration between cases and controls. A total of 1319 encounters/253 patients were included in this study. AKI was noted in 1.1% of encounters and 5.5% of patients. Cases had significantly higher initial BUN than controls (9.0 vs. 6.0 mg/dL, P=0.012). In cases versus controls, there was significantly lower serum sodium (136.0 vs. 138.0 mmol/L, P=0.021). There was no association between ketorolac dose and development of AKI among children with SCD. Higher BUN and lower sodium in cases suggest that patients with AKI were more volume depleted on admission than controls. This highlights the need for strict assessment of fluid status upon admission for VOE.

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Urinary protein profiles in ketorolac-associated acute kidney injury in patients undergoing orthopedic day surgery

Cited by 5 publications

References 17 publications

Ketorolac Use for Pain Management in Trauma Patients With Rib Fractures Does not Increase of Acute Kidney Injury or Incidence of Bleeding

Ketorolac Use for Pain Management in Trauma Patients With Rib Fractures Does not Increase of Acute Kidney Injury or Incidence of Bleeding

Chronic kidney disease and acute kidney injury in arthroplasty patients over 65 years of age

The Risk of Kidney Injury in Patients With Sickle Cell Disease Treated With Ketorolac for Acute Pain

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