From the Guidelines
Ketamine can be nephrotoxic, particularly with long-term or high-dose use, and its potential for kidney damage is most concerning in cases of chronic abuse or prolonged medical use. The main kidney-related effects of ketamine include:
- Lower urinary tract symptoms (LUTS)
- Interstitial cystitis
- Hydronephrosis
- Renal dysfunction To minimize kidney risks when using ketamine:
- Use the lowest effective dose
- Limit duration of use when possible
- Monitor renal function regularly in patients receiving long-term ketamine
- Be cautious in patients with pre-existing kidney disease The mechanism of ketamine's nephrotoxicity is not fully understood but may involve direct damage to the urinary tract epithelium, increased bladder permeability, and neurogenic inflammation, as discussed in the context of drug-induced kidney injury and dysfunction 1. Typical medical doses for anesthesia or short-term pain management are generally considered safe for the kidneys in patients with normal renal function, but the use of ketamine should be approached with caution, especially in patients requiring long-term use or those with risk factors for kidney disease 1.
In the context of ketamine's use, it is essential to consider the potential risks and benefits, particularly in patients with pre-existing kidney disease or those requiring long-term use, and to weigh these against the potential benefits of ketamine, as its use can lead to kidney dysfunction or injury, as noted in the discussion of nephrotoxic agents and drugs that affect kidney function 1. The classification of drugs that affect kidney function or are nephrotoxic is complex, and a framework for understanding these mechanisms is necessary to guide clinical decision-making, as outlined in the Kidney Disease: Improving Global Outcomes (KDIGO) conference conclusions 1.
Healthcare providers should be aware of the potential nephrotoxic effects of ketamine and take steps to minimize these risks, including using the lowest effective dose, limiting duration of use, and monitoring renal function regularly in patients receiving long-term ketamine, as part of a comprehensive approach to managing patients who require ketamine therapy, and considering the potential for kidney injury or dysfunction in the context of ketamine use 1.
From the FDA Drug Label
Renal and urinary disorders: In individuals with history of chronic ketamine use or abuse, lower urinary tract and bladder symptoms including dysuria, increased urinary frequency, urgency, urge incontinence, and hematuria have been reported [see Dosage and Administration (2. 1)]. In addition, diagnostic studies performed to assess the cause of these symptoms have reported cystitis (including cystitis non-infective, cystitis interstitial, cystitis ulcerative, cystitis erosive and cystitis hemorrhagic) as well as hydronephrosis and reduced bladder capacity
Ketamine is associated with renal and urinary disorders, including cystitis and hydronephrosis, particularly in individuals with a history of chronic use or abuse 2. However, the label does not explicitly state that ketamine is nephrotoxic.
- Key points:
- Chronic ketamine use or abuse is associated with lower urinary tract and bladder symptoms
- Diagnostic studies have reported cystitis and hydronephrosis in individuals with a history of chronic ketamine use or abuse
- The label does not provide direct evidence of ketamine's nephrotoxicity 2
From the Research
Ketamine Nephrotoxicity
- There is evidence to suggest that ketamine may be associated with nephrotoxicity, particularly with chronic use 3, 4.
- Chronic ketamine use has been linked to lower urinary tract symptoms, including cystitis 3, 4.
- However, the current evidence does not suggest that ketamine is directly nephrotoxic, but rather that its metabolites may contribute to nephrotoxicity 3.
- The elimination of ketamine is primarily by the kidneys, though unchanged ketamine accounts for only a small percentage in the urine 3.
Mechanisms of Ketamine-Induced Nephrotoxicity
- The exact mechanisms of ketamine-induced nephrotoxicity are not fully understood, but it is thought to be related to the drug's metabolites, such as norketamine and hydroxynorketamine 3.
- These metabolites may cause damage to the kidneys and urinary tract, leading to symptoms such as cystitis and lower urinary tract symptoms 3, 4.
Clinical Implications
- The use of ketamine should be carefully monitored, particularly in patients with pre-existing kidney disease or those who are at risk of developing kidney problems 3, 4.
- Patients who experience symptoms such as cystitis or lower urinary tract symptoms while using ketamine should be evaluated for potential nephrotoxicity 3, 4.
- Further research is needed to fully understand the mechanisms of ketamine-induced nephrotoxicity and to develop strategies for preventing and treating this condition 5, 6, 7.