Atypical antipsychotics linked with acute kidney injury in the elderly

1.   Atypical antipsychotics given to elderly patients in outpatient setting were associated with a 75% increased 90-day risk of hospitalization for acute kidney injury (AKI) when compared to untreated controls.

2.  Older patients taking atypical antipsychotics were nearly twice as likely to develop multiple severe complications, including death. 

Evidence Rating Level: 2 (Good) 

Study Rundown: Atypical antipsychotics including olanzapine, quetiapine, and risperidone are frequently used to manage the behavioral symptoms of dementia in the elderly. The Federal Drug Agency (FDA) has issued a black box warning for these drugs based on 17 trials that demonstrated an increased rate of death in elderly patients with dementia taking these drugs. This population-based retrospective cohort study sought to examine the risk of hospitalization secondary to acute kidney injury (AKI) and other adverse outcomes associated with new oral atypical antipsychotic use in the elderly.  The study included residents of Ontario, Canada aged older than 65 years who received a new prescription for atypical antipsychotics in the non-hospital setting. Patients that received these drugs, when compared to untreated matched controls, were at significantly increased risk of hospitalization for acute kidney injury (AKI).  The results also suggested an association between atypical antipsychotic use and other complications including hypotension, acute urinary retention, pneumonia, acute myocardial infarction and ventricular arrhythmia. Furthermore, subjects that were taking these drugs were over twice as likely to die from any cause during the 90-day follow-up period. A major weakness of this study was the limited study population, as well as the failure to identify and include patients who experienced AKI without hospitalization as a study outcome.

Click to read the study, published today in the Annals of Internal Medicine

Relevant Reading: The Efficacy and Safety of Atypical Antipsychotics for the Treatment of Dementia: A Meta-Analysis of Randomized Placebo-Controlled Trials

In-Depth [retrospective cohort]: This study is a population-based retrospective cohort study.  The study included patients from Ontario, Canada aged 65 years and older with outpatient prescribed atypical antipsychotics between 2003 and 2012. The 97,777 patients that were eligible for inclusion in the study were matched by 97,777 controls. Compared to the controls, the cohort of elderly patients on atypical antipsychotics were at significantly increased risk of hospitalization for AKI (RR 1.73, CI 1.55-192), hypotension (RR1.91, CI 1.60-2.28), acute urinary retention (RR 1.98, CI 1.63-2.40), pneumonia (RR 1.50, CI 1.39-1.62), AMI (RR 1.36, CI 1.20-1.53), ventricular arrhythmia (RR 1.47, CI 1.18-1.82) and all-cause mortality (RR 2.23, CI 2.28-2.50). This study demonstrated that severe multisystem complications and reduced survival must be considered when physicians prescribe these medications to manage the behavioral symptoms of dementia.

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