Atypical Antipsychotics Linked to AKI Risk

Older adults taking atypical antipsychotic drugs may be at increased risk of acute kidney injury (AKI), reports a study in the Annals of Internal Medicine.

Ontario health data were used to identify 97,777 adults aged 65 or older who received a new outpatient prescription for an oral atypical antipsychotic drug between 2003 and 2012. The drugs of interest were quetiapine, risperidone, and olanzapine. These patients were matched to the same number of control individuals with no such prescription. The rates of hospitalization for AKI, based on hospital diagnosis codes, within 90 days of the atypical antipsychotic prescription were compared between groups.

The patients prescribed atypical antipsychotics were at significantly increased risk of hospitalization with AKI: relative risk (RR) 1.73. The association remained significant in a subpopulation of patients with available data on serum creatinine levels: AKI risk was 5.46 versus 3.34 percent, for an absolute risk increase of 2.12 percent. Atypical antipsychotic drugs were also associated with an increased risk of hypotension, RR 1.91; acute urinary retention, RR 1.98; and all-cause mortality, RR 2.39.

Some adverse outcomes associated with atypical antipsychotic drugs, including hypotension, acute urinary retention, and the neuroleptic malignant syndrome or rhabdomyolysis, are known causes of AKI. These population-based data suggest an increased risk of AKI in older adults prescribed atypical antipsychotic drugs.

Atypical antipsychotic drugs are also linked to other adverse outcomes that might explain the increase in AKI. “The findings support current safety concerns about the use of these drugs in older adults,” the investigators conclude [Hwang YJ, et al. Atypical antipsychotic drugs and the risk for acute kidney injury and other adverse outcomes in older adults: a population-based cohort study. Ann Intern Med 2014; 161:242–248].