Confounding by indication? This is the problem with many retrospective antipsychotic studies. Those prescribed the drugs are likely to become dehydrated, hypotensive, and AKI because of the dementia!
Atypical Antipsychotics Linked to Acute Kidney Injury in Elders — Physician’s First Watch
Atypical Antipsychotics Linked to Acute Kidney Injury in Elders
By Amy Orciari Herman
Edited by Jaye Elizabeth Hefner, MD
Older adults who begin taking atypical antipsychotics face increased risk for acute kidney injury in the first few months of use, according to a retrospective study in the Annals of Internal Medicine.
Using Canadian healthcare databases, researchers matched nearly 98,000 adults aged 65 and older with new outpatient prescriptions for atypical antipsychotics (risperidone, quetiapine, or olanzapine) to older adults without such prescriptions. Matching took into account comorbid conditions and other factors.
The primary outcome — hospitalization for acute kidney injury in the 90 days after prescription receipt (or matched date) — occurred significantly more often among antipsychotic recipients than controls (1.02% vs. 0.62%). In addition, hypotension, acute urinary retention, acute MI, and all-cause mortality occurred more often with antipsychotics.
The authors write, "The current available evidence calls for a careful reevaluation of prescribing atypical antipsychotic drugs in older adults, especially for the unapproved indication of managing behavioral symptoms of dementia. The drugs should be used only after other approaches have been exhausted; when prescribed, patients must be warned about potential adverse effects."