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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. DESIGN:Population-based cohort study. SETTING:Ontario, Canada, from 2003 to 2012. PATIENTS: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. MEASUREMENTS: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]). LIMITATION:Only older adults were included in the study. CONCLUSION: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. PRIMARY FUNDING SOURCE:Academic Medical Organization of Southwestern Ontario.

journal_name

Ann Intern Med

journal_title

Annals of internal medicine

authors

Hwang YJ,Dixon SN,Reiss JP,Wald R,Parikh CR,Gandhi S,Shariff SZ,Pannu N,Nash DM,Rehman F,Garg AX

doi

10.7326/M13-2796

subject

Has Abstract

pub_date

2014-08-19 00:00:00

pages

242-8

issue

eissn

0003-4819

issn

1539-3704

pii

1897100

journal_volume

161

pub_type

杂志文章

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Atypical antipsychotic drugs and the risk for acute kidney injury and other adverse outcomes in older adults: a population-based cohort study.