From the Research
Ketamine is generally considered safe for use in patients with Acute Kidney Injury (AKI) and may be preferred over other anesthetic agents in this population. The most recent and highest quality study, 1, published in 2024, provides a comprehensive review of current approaches and emerging innovations in the treatment of AKI, but does not specifically address the use of ketamine in AKI. However, based on the pharmacokinetics of ketamine, which is primarily metabolized by the liver through N-demethylation to norketamine, with minimal renal excretion of unchanged drug, ketamine does not require dose adjustment in AKI. The standard dosing remains applicable: 1-2 mg/kg IV for induction, 0.5-1 mg/kg IM for procedural sedation, or 0.1-0.5 mg/kg/hr for continuous infusion.
Some key considerations when using ketamine in patients with AKI include:
- Monitoring for emergence reactions, as ketamine's metabolites can accumulate in renal failure and potentially prolong psychomimetic effects 2
- Using prophylactic benzodiazepines, such as midazolam 1-2 mg IV, to mitigate emergence reactions
- Avoiding ketamine in patients with severe hypertension or increased intracranial pressure, conditions that sometimes coexist with AKI
- Maintaining hemodynamic stability through sympathomimetic effects, which can help preserve renal perfusion in critically ill patients 3
Overall, the use of ketamine in patients with AKI should be guided by a thorough understanding of the patient's underlying medical condition, as well as the potential benefits and risks of ketamine therapy, as discussed in 4.