Effects of ondansetron use on outcomes of acute kidney injury in critically ill patients: An analysis based on the MIMIC-IV database

Purpose: Acute kidney injury (AKI) in intensive care units (ICUs) is a health priority with limited treatment options. This study aimed to estimate the effects of ondansetron use on AKI patient outcomes.

Materials and methods: We used the MIMIC-IV database to compare AKI patient mortality in the ICU with and without ondansetron and calculated hazard ratios (HRs) with 95% confidence intervals (95%CI) by multivariable Cox regression. Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were applied to adjust for confounding factors.

Results: In total, 26,004 AKI patients were included. Ondansetron use reduced in-hospital mortality risk by 16% among AKI patients (HR: 0.84, 95%CI: 0.77-0.90, p < 0.001). In-hospital mortality was significantly reduced among patients administered ondansetron at AKI stage 1 (11.4% vs. 16.5%. p < 0.001) and stage 2 (16.1% vs. 19.6%. p < 0.001) but not stage 3 (24.0% vs. 23.9%. p = 0.890). Patients younger than 60 years or receiving surgery received greater benefits from ondansetron use. (HR: 0.62, 95%CI:0.53-0.72 and HR: 0.59, 95%CI:0.50-0.69, respectively).

Conclusions: This cohort study showed that ondansetron use is significantly associated with reduced risk-adjusted in-hospital mortality in stages 1 and 2 AKI patients in the ICU. Further randomized controlled trials are needed.