BACKGROUND: Acute renal failure has been associated with parenteral ketorolac tromethamine, but the risk that is associated with this therapy has not been quantified. OBJECTIVE: To compare the risk for acute renal failure associated with ketorolac with that associated with opioids. DESIGN: Retrospective cohort study. SETTING: 35 hospitals in or near Philadelphia. PATIENTS: Patients receiving 10,219 courses of parenteral ketorolac and patients receiving 10,145 courses of parenteral opioids. MEASUREMENTS: Acute renal failure was defined by 1) an increase in the serum creatinine concentration of 50% or more and 2) either an absolute increase of 44.2 mumol/L or more for concentrations that were less than 132.6 mumol/L at baseline or an absolute increase of 88.4 mumol/L or more for concentrations that were 132.6 mumol/L or more at baseline. In addition, a secondary definition required a diagnosis by a physician. RESULTS: The overall incidence of acute renal failure was 1.1% after therapy with either ketorolac or opioids. Multivariate-adjusted rate ratios comparing ketorolac with opioids for acute renal failure were 1.09 (95% CI, 0.83 to 1.42) overall, 1.00 (CI, 0.76 to 1.33) for less than 5 days of therapy, and 2.08 (CI, 1.08 to 4.00; P = 0.03) for more than 5 days of therapy. Similar results were obtained when the secondary definition of acute renal failure was used. CONCLUSIONS: Overall, acute renal failure was uncommon in this hospitalized population. Compared with opioids, ketorolac administered for 5 days or less did not increase the rate of renal failure. However, among patients who were treated with analgesics for more than 5 days, ketorolac may be associated with an elevated rate of acute renal failure.
BACKGROUND:Acute renal failure has been associated with parenteral ketorolac tromethamine, but the risk that is associated with this therapy has not been quantified. OBJECTIVE: To compare the risk for acute renal failure associated with ketorolac with that associated with opioids. DESIGN: Retrospective cohort study. SETTING: 35 hospitals in or near Philadelphia. PATIENTS: Patients receiving 10,219 courses of parenteral ketorolac and patients receiving 10,145 courses of parenteral opioids. MEASUREMENTS: Acute renal failure was defined by 1) an increase in the serum creatinine concentration of 50% or more and 2) either an absolute increase of 44.2 mumol/L or more for concentrations that were less than 132.6 mumol/L at baseline or an absolute increase of 88.4 mumol/L or more for concentrations that were 132.6 mumol/L or more at baseline. In addition, a secondary definition required a diagnosis by a physician. RESULTS: The overall incidence of acute renal failure was 1.1% after therapy with either ketorolac or opioids. Multivariate-adjusted rate ratios comparing ketorolac with opioids for acute renal failure were 1.09 (95% CI, 0.83 to 1.42) overall, 1.00 (CI, 0.76 to 1.33) for less than 5 days of therapy, and 2.08 (CI, 1.08 to 4.00; P = 0.03) for more than 5 days of therapy. Similar results were obtained when the secondary definition of acute renal failure was used. CONCLUSIONS: Overall, acute renal failure was uncommon in this hospitalized population. Compared with opioids, ketorolac administered for 5 days or less did not increase the rate of renal failure. However, among patients who were treated with analgesics for more than 5 days, ketorolac may be associated with an elevated rate of acute renal failure.
Authors: Toby N Weingarten; James M Swain; Michael L Kendrick; Michael R Charlton; Brent J Schroeder; Robert E Citrowske Lee; Bradly J Narr; Tarsila C R Ribeiro; Darrell R Schroeder; Juraj Sprung Journal: Obes Surg Date: 2011-11 Impact factor: 4.129
Authors: Gwen M Grimsby; Sarah P Conley; Terrence L Trentman; Erik P Castle; Paul E Andrews; Laurie A Mihalik; Joseph G Hentz; Mitchell R Humphreys Journal: Mayo Clin Proc Date: 2012-10-08 Impact factor: 7.616