Ketorolac Use in Chronic Kidney Disease

Mechanism of Kidney Damage

• Ketorolac inhibits prostaglandin synthesis, which is critical for maintaining renal perfusion, especially in patients with compromised kidney function, and can cause a dose-dependent reduction in renal perfusion 1, 2

Guidelines on NSAIDs in CKD

• The Kidney Disease: Improving Global Outcomes (KDIGO) guidelines recommend avoiding nephrotoxic medications such as NSAIDs in patients with CKD 3, 4
• The Acute Disease Quality Initiative (ADQI) consensus report specifically mentions withholding NSAIDs during the persistent or recovery phase of acute kidney disease 1, 2
• KDOQI guidelines specifically list NSAIDs as medications to avoid in people with GFR < 30 ml/min/1.73 m² 5

Risk Factors That Increase Nephrotoxicity

• The risk of ketorolac nephrotoxicity is significantly increased when combined with other nephrotoxic medications 2
• The risk of ketorolac nephrotoxicity is also increased when combined with ACE inhibitors or ARBs 2

Alternative Pain Management Approaches for CKD Patients

• For pain management in CKD patients, consider careful use of opioids with dose adjustment based on GFR 5