Acute kidney injury more common among patients prescribed a class of common antipsychotics

Each year, millions of older adults worldwide are prescribed a class of antipsychotic drugs called atypical or second-generation antipsychotics to manage behavioural symptoms of dementia. In a new study, researchers at the Lawson Health Research Institute (Lawson) and the Institute for Clinical Evaluative Sciences (ICES) show that these patients are at a higher risk for acute kidney injury (AKI) and other adverse side effects than patients not prescribed these drugs.

“The U.S. Food and Drug Administration warns of increased risk for death in older patients treated with these drugs, but studies are limited,” says lead author Dr. Amit Garg, a scientist at Lawson and ICES, a kidney specialist at the London Health Sciences Centre and a professor of medicine and epidemiology at Western University’s Schulich School of Medicine and Dentistry. “Though not an approved indication, these drugs are frequently used to manage behavioural symptoms of dementia. This use has raised safety concerns.”

Adverse outcomes associated with these drugs, such as low blood pressure, acute urinary retention (inability to pass urine) and the breakdown of muscle tissue (rhabdomyolysis), are known to cause AKI.  Moreover, pneumonia, heart attacks and dangerous heart rhythm disturbances have also been associated with these drugs.

For these reasons, the researchers did a population-based study of older adults to investigate the 90-day risk of hospitalization with AKI and other adverse outcomes from new use of the drug. They looked at almost 100,000 patients 65 years and older who were prescribed either quetiapine, risperidone or olanzapine and followed the outcomes of these patients for 90 days after the date of the original prescription. The comparison group was another 100,000 patients who were similar to the antipsychotic drug users in their baseline health but who were not prescribed the drug.

“The results of this study call for a careful reevaluation of prescribing atypical antipsychotic drugs in older adults, especially for the unapproved indication of managing behavioural symptoms of dementia. The drugs should be used after other approaches have been exhausted, and when prescribed, patients must be warned about potential adverse effects,” cautions Dr. Garg.  “Also, when patients present with AKI, atypical antipsychotic drugs should be considered a potential cause and promptly discontinued if possible.”

“Atypical antipsychotic drugs and the risk for acute kidney injury and other adverse outcomes in older adults: a population-based cohort study” was published in the August issue of Annals of Internal Medicine.

The authors are Y. Joseph Hwang (first author; MSc thesis); Stephanie Dixon, Jeffrey Reiss, Ron Wald, Chirag Parikh, Sonja Gandhi, Salimah Shariff, Neesh Pannu, Danielle Nash, Faisal Rehman and Amit Garg.

Lawson Health Research Institute. As the research institute of London Health Sciences Centre and St. Joseph's Healthcare, London, and working in partnership with The University of Western Ontario, Lawson Health Research Institute is committed to furthering scientific knowledge to advance healthcare around the world. www.lawsonresearch.com

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.

This work was done by the new provincial ICES Kidney, Dialysis and Transplantation Research Program.

For more information, please contact:

• Julia Capaldi
• Communications & Public Relations Lawson Health Research Institute
• [email protected]
• (o) 519-685-8500 ext. 75852  (c) 519-200-1115

• Deborah Creatura
• Media Advisor, ICES
• [email protected]
• (o) 416-480-4780 or (c) 647-406-5996