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A Retrospective Cohort Study of Acute Kidney Injury Risk Associated with Antipsychotics
Yawen Jiang1, Jeffrey S McCombs2, Susie H Park3
1Department of Pharmaceutical and Health Economics, Leonard D. Schaeffer Center for Health Policy and Economics, School of Pharmacy, University of Southern California, USC Schaeffer Center, Verna and Peter Dauterive Hall (VPD), 635 Downey Way, Los Angeles, CA, 90089-3333, USA. yawenjia@usc.edu.
CNS Drugs
|March 15, 2017
Summary
Certain antipsychotics, particularly atypical ones like olanzapine, quetiapine, and ziprasidone, are linked to a higher risk of acute kidney injury (AKI). Clinicians should consider patient vulnerability when prescribing these medications.
Area of Science:
- Pharmacology
- Nephrology
- Psychiatry
Background:
- A prior analysis indicated a potential acute kidney injury (AKI) risk with antipsychotic use.
- However, differential AKI risks among specific typical and atypical antipsychotics remained unexamined.
Purpose of the Study:
- To compare the risks of AKI and its known causes across various typical and atypical antipsychotics.
- To investigate if certain antipsychotics pose a greater AKI risk than others.
Main Methods:
- A retrospective cohort analysis of US nationwide claims data (2007-2013) for schizophrenia and bipolar disorder patients.
- Cox regression models compared risks of AKI associated with aripiprazole, fluphenazine, haloperidol, olanzapine, quetiapine, risperidone, and ziprasidone, using haloperidol as a baseline.
- Models controlled for patient demographics, treatment history, comorbidities, and concomitant drug use.
Main Results:
- Olanzapine, quetiapine, and ziprasidone were associated with significantly increased AKI risks compared to haloperidol.
- Atypical antipsychotics as a class showed a significantly higher AKI risk than typical antipsychotics.
- Aripiprazole and risperidone showed non-significantly higher AKI risks, while fluphenazine showed a non-significantly lower risk.
Conclusions:
- Antipsychotics exhibit differential risks for AKI, with some atypical agents posing a higher risk than haloperidol.
- The overall AKI incidence was moderate, suggesting concern primarily for elderly or kidney-vulnerable patients.
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