title: Atypical antipsychotic drugs and the risk for acute kidney injury and other adverse outcomes in older adults: a population-based cohort study.
abstract: BACKGROUND
  Several adverse outcomes attributed to atypical antipsychotic drugs, specifically quetiapine, risperidone, and olanzapine, are known to cause acute kidney injury (AKI). Such outcomes include hypotension, acute urinary retention, and the neuroleptic malignant syndrome or rhabdomyolysis.
  
  
  OBJECTIVE
  To investigate the risk for AKI and other adverse outcomes associated with use of atypical antipsychotic drugs versus nonuse.
  
  
  METHODS
  Population-based cohort study.
  
  
  METHODS
  Ontario, Canada, from 2003 to 2012.
  
  
  METHODS
  Adults aged 65 years or older who received a new outpatient prescription for an oral atypical antipsychotic drug (n=97,777) matched 1:1 with those who did not receive such a prescription.
  
  
  METHODS
  The primary outcome was hospitalization with AKI (assessed by using a hospital diagnosis code and, in a subpopulation, serum creatinine levels) within 90 days of prescription for atypical antipsychotic drugs.
  
  
  RESULTS
  Atypical antipsychotic drug use versus nonuse was associated with a higher risk for hospitalization with AKI (relative risk [RR], 1.73 [95% CI, 1.55 to 1.92]). This association was consistent when AKI was assessed in a subpopulation for which information on serum creatinine levels was available (5.46% vs. 3.34%; RR, 1.70 [CI, 1.22 to 2.38]; absolute risk increase, 2.12% [CI, 0.80% to 3.43%]). Drug use was also associated with hypotension (RR, 1.91 [CI, 1.60 to 2.28]), acute urinary retention (RR, 1.98 [CI, 1.63 to 2.40]), and all-cause mortality (RR, 2.39 [CI, 2.28 to 2.50]).
  
  
  CONCLUSIONS
  Only older adults were included in the study.
  
  
  CONCLUSIONS
  Atypical antipsychotic drug use is associated with an increased risk for AKI and other adverse outcomes that may explain the observed association with AKI. The findings support current safety concerns about the use of these drugs in older adults.
  
  
  BACKGROUND
  Academic Medical Organization of Southwestern Ontario.
authors.forename: Y Joseph
authors.initials: YJ
authors.lastname: Hwang
authors.forename: Stephanie N
authors.initials: SN
authors.lastname: Dixon
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Reiss
authors.forename: Ron
authors.initials: R
authors.lastname: Wald
authors.forename: Chirag R
authors.initials: CR
authors.lastname: Parikh
authors.forename: Sonja
authors.initials: S
authors.lastname: Gandhi
authors.forename: Salimah Z
authors.initials: SZ
authors.lastname: Shariff
authors.forename: Neesh
authors.initials: N
authors.lastname: Pannu
authors.forename: Danielle M
authors.initials: DM
authors.lastname: Nash
authors.forename: Faisal
authors.initials: F
authors.lastname: Rehman
authors.forename: Amit X
authors.initials: AX
authors.lastname: Garg
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D014150:Antipsychotic Agents / Q000009:adverse effects*; D001569:Benzodiazepines / Q000009:adverse effects; D002423:Cause of Death; D003404:Creatinine / Q000097:blood; D003987:Dibenzothiazepines / Q000009:adverse effects; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007022:Hypotension / Q000139:chemically induced; D008297:Male; D000077152:Olanzapine; D009864:Ontario / Q000453:epidemiology; D000069348:Quetiapine Fumarate; D012189:Retrospective Studies; D012307:Risk Factors; D018967:Risperidone / Q000009:adverse effects; D016055:Urinary Retention / Q000139:chemically induced
chemical_list: D014150:Antipsychotic Agents; D003987:Dibenzothiazepines; D001569:Benzodiazepines; D000069348:Quetiapine Fumarate; D003404:Creatinine; D018967:Risperidone; D000077152:Olanzapine