What does a long article mean? In the live version of the Geriatric Medicine Journal Club held at the University of Toronto, 45 minutes is devoted to the presentation and discussion of the article.
Atypical Antipsychotic Drugs and the Risk for Acute Kidney Injury and Other Adverse Outcomes in Older Adults. Ann Intern Med. 2014;161:242-248.
The long article chosen is an Ontario based study conducted at the Institute for Clinical Evaluative Sciences (ICES). It is sure to be of interest! Atypical antipsychotics are getting a lot of bad press and here is just some fuel to the fire. Perhaps the participants from the Nephrology Journal Club (#NephJC) would be interested in this critical appraisal of this article too.
The article can be found here: and the abstract is posted below.
Engage in the discussion September 19, 2014 at 08:00 EDT / noon GMT and don't forget to use the hashtag #GeriMedJC.
BACKGROUND: Several adverse outcomes attributed to atypical antipsychotic drugs, specifically quetiapine, risperidone, and olanzapine, are known to cause acute kidney injury (AKI). Such outcomes include hypotension, acute urinary retention, and the neuroleptic malignant syndrome or rhabdomyolysis.
OBJECTIVE: To investigate the risk for AKI and other adverse outcomes associated with use of atypical antipsychotic drugs versus nonuse.
DESIGN: Population-based cohort study.
SETTING: Ontario, Canada, from 2003 to 2012.
PATIENTS: Adults aged 65 years or older who received a new outpatient prescription for an oral atypical antipsychotic drug (n = 97 777) matched 1:1 with those who did not receive such a prescription.
MEASUREMENTS: The primary outcome was hospitalization with AKI (assessed by using a hospital diagnosis code and, in a subpopulation, serum creatinine levels) within 90 days of prescription for atypical antipsychotic drugs.
RESULTS: Atypical antipsychotic drug use versus nonuse was associated with a higher risk for hospitalization with AKI (relative risk [RR], 1.73 [95% CI, 1.55 to 1.92]). This association was consistent when AKI was assessed in a subpopulation for which information on serum creatinine levels was available (5.46% vs. 3.34%; RR, 1.70 [CI, 1.22 to 2.38]; absolute risk increase, 2.12% [CI, 0.80% to 3.43%]). Drug use was also associated with hypotension (RR, 1.91 [CI, 1.60 to 2.28]), acute urinary retention (RR, 1.98 [CI, 1.63 to 2.40]), and all-cause mortality (RR, 2.39 [CI, 2.28 to 2.50]).
LIMITATION: Only older adults were included in the study.
CONCLUSION: Atypical antipsychotic drug use is associated with an increased risk for AKI and other adverse outcomes that may explain the observed association with AKI. The findings support current safety concerns about the use of these drugs in older adults.
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