Ketorolac dosage does not appear to predict the risk of acute kidney injury among pediatric patients with sickle cell disease (SCD) presenting with a vaso-occlusive pain episode, according to research presented at the 2021 American Society of Pediatric Hematology/Oncology (ASPHO) meeting.

Among patients with SCD, more than 90% of hospital admissions are due to a vaso-occlusive pain episode. While ketorolac – a non-steroidal anti-inflammatory drug – is used frequently in this setting alongside opioids for pain management, any link between ketorolac-use and acute kidney injury, while possible, has not been firmly established.

For this retrospective review and a matched case-control analysis, researchers evaluated patient chart data to determine the rate of acute kidney injury among patients with SCD treated with ketorolac, and further to determine whether ketorolac dosage affected AKI rates. All included patients were hospitalized for a vaso-occlusive pain event between 2014 and 2019; acute kidney injury was defined as an increase of serum creatinine of at least 0.3 mg/dL or a 50% increase from the patient’s preadmission baseline.

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Overall, data from 210 patients, for whom 910 encounters were recorded, were included in the study. Approximately half (50.5%) of patients were female, the median age at admission was 15.4 years, and the median number of hospital admissions per patient was 2 (interquartile ratio, 1-4).

Acute kidney injury occurred in 12 (1.3%) patients in the case group vs 24 in the control group. Between the case and control groups, the authors noted no significance difference in daily ketorolac dosage (P =.814) or in the overall number of ketorolac doses (P =.839).

Patients in the case group had both higher serum creatinine (0.56 mg/dL vs 0.32 mg/dL in the control group; P =.002) and higher blood urea nitrogen (9.5 vs 6.0, respectively; P =.015).

“Higher [blood urea nitrogen] and creatinine on admission suggest that cases often present with [acute kidney injury],” the authors wrote. “These findings highlight the ketorolac dose-independent risk of [acute kidney injury] among children with SCD and the need for more research focused on underlying mechanisms.”


Harris E, Solodiuk J, Greco C, Donado Rincon C, Archer N. Risk of acute kidney injury during vaso-occlusive pain episodes managed with ketorolac. Paper presented at: 2021 American Society of Pediatric Hematology/Oncology (ASPHO) Annual Meeting; April 20-23, 2021; virtual.