title: Parenteral ketorolac: the risk for acute renal failure.
abstract: 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.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  35 hospitals in or near Philadelphia.
  
  
  METHODS
  Patients receiving 10,219 courses of parenteral ketorolac and patients receiving 10,145 courses of parenteral opioids.
  
  
  METHODS
  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.affiliation: University of Pennsylvania Medical Center, Philadelphia, USA.
authors.forename: H I
authors.initials: HI
authors.lastname: Feldman
authors.forename: J L
authors.initials: JL
authors.lastname: Kinman
authors.forename: J A
authors.initials: JA
authors.lastname: Berlin
authors.forename: S
authors.initials: S
authors.lastname: Hennessy
authors.forename: S E
authors.initials: SE
authors.lastname: Kimmel
authors.forename: J
authors.initials: J
authors.lastname: Farrar
authors.forename: J L
authors.initials: JL
authors.lastname: Carson
authors.forename: B L
authors.initials: BL
authors.lastname: Strom
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000139:chemically induced*; D000328:Adult; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D020910:Ketorolac; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009294:Narcotics / Q000008:administration & dosage / Q000009:adverse effects; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D014046:Tolmetin / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*
chemical_list: D018712:Analgesics, Non-Narcotic; D009294:Narcotics; D003404:Creatinine; D014046:Tolmetin; D020910:Ketorolac