{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T23:44:57Z","timestamp":1768261497544,"version":"3.49.0"},"reference-count":30,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2020,10,4]],"date-time":"2020-10-04T00:00:00Z","timestamp":1601769600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Ketamine-associated diseases have been increasing with the rise in ketamine abuse. Ketamine-associated uropathy is one of the most common complications. We investigated the effects of ketamine-associated uropathy on renal health and determined predictors of renal function decline in chronic ketamine abusers. This retrospective cohort study analyzed 51 patients (22 with ketamine-associated hydronephrosis and 29 with ketamine cystitis) from Kaohsiung Veterans General Hospital in Taiwan. Primary renal outcome was end-stage renal disease or estimated glomerular filtration rate decline &gt;30% from baseline. Compared with the ketamine cystitis group, the hydronephrosis group had lower initial and final estimated glomerular filtration rates and higher alkaline phosphatase and gamma-glutamyl transferase levels (p &lt; 0.05). Elevated cholestatic liver enzyme levels correlated with renal dysfunction in ketamine-associated uropathy. The hydronephrosis group had a higher proportion of patients reaching endpoints than the ketamine cystitis group (50% and 7%, respectively, p &lt; 0.001). After adjusting for age, sex, and initial serum creatinine level, hydronephrosis remained an independent risk factor for renal function deterioration. Ketamine-associated hydronephrosis was a poor renal outcome and strong predictor of renal function decline in chronic ketamine abusers. Elevated cholestatic liver enzyme levels correlated with the severity of ketamine-associated uropathy. Ultrasonography screening of these high-risk groups and regular renal function follow-ups are necessary.<\/jats:p>","DOI":"10.3390\/ijerph17197260","type":"journal-article","created":{"date-parts":[[2020,10,5]],"date-time":"2020-10-05T08:35:57Z","timestamp":1601886957000},"page":"7260","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Risk of Renal Function Decline in Patients with Ketamine-Associated Uropathy"],"prefix":"10.3390","volume":"17","author":[{"given":"Shih-Hsiang","family":"Ou","sequence":"first","affiliation":[{"name":"Division of Nephrology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan"},{"name":"Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei 112, Taiwan"},{"name":"Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ling-Ying","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hsin-Yu","family":"Chen","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan"},{"name":"Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei 112, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chien-Wei","family":"Huang","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan"},{"name":"Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei 112, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chih-Yang","family":"Hsu","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan"},{"name":"Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei 112, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9508-8396","authenticated-orcid":false,"given":"Chien-Liang","family":"Chen","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan"},{"name":"Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei 112, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kang-Ju","family":"Chou","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan"},{"name":"Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei 112, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hua-Chang","family":"Fang","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan"},{"name":"Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei 112, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Po-Tsang","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan"},{"name":"Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei 112, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2020,10,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e50","DOI":"10.1097\/YCT.0000000000000167","article-title":"Combined ketamine\/transcranial magnetic stimulation treatment of severe depression in bipolar I disorder","volume":"30","author":"Best","year":"2014","journal-title":"J. ECT"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"247","DOI":"10.4088\/JCP.13m08852","article-title":"Ketamine safety and tolerability in clinical trials for treatment-resistant depression","volume":"76","author":"Wan","year":"2015","journal-title":"J. Clin. Psychiatry"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"7107","DOI":"10.3402\/ehtj.v4i0.7107","article-title":"The epidemiology and patterns of acute and chronic toxicity associated with recreational ketamine use","volume":"4","author":"Kalsi","year":"2011","journal-title":"Emerg. Health Threats J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1016\/j.jfda.2014.01.019","article-title":"Analysis of drug abuse data reported by medical institutions in Taiwan from 2002 to 2011","volume":"22","author":"Hsu","year":"2014","journal-title":"J. Food Drug Anal."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1016\/j.jfda.2013.09.003","article-title":"The trend of drug abuse in Taiwan during the years 1999 to 2011","volume":"21","author":"Lee","year":"2013","journal-title":"J. Food Drug Anal."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1016\/j.tacc.2014.03.002","article-title":"Ketamine\u2014More mechanisms of action than just NMDA blockade","volume":"4","author":"Sleigh","year":"2014","journal-title":"Trends Anaesth. Crit. Care"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1159\/000438675","article-title":"Ketamine-induced hallucinations","volume":"48","author":"Gancsos","year":"2015","journal-title":"Psychopathology"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1080\/20961790.2017.1285219","article-title":"Metabolism and metabolomics of ketamine: A toxicological approach","volume":"2","year":"2017","journal-title":"Forensic Sci. Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1093\/jat\/29.5.376","article-title":"Urinary excretion rates of ketamine and norketamine following therapeutic ketamine administration: Method and detection window considerations","volume":"29","author":"Adamowicz","year":"2005","journal-title":"J. Anal. Toxicol."},{"key":"ref_10","first-page":"175","article-title":"Management of complications of ketamine abuse: 10 years\u2019 experience in Hong Kong","volume":"24","author":"Hong","year":"2018","journal-title":"Hong Kong Med. J."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1616","DOI":"10.1111\/j.1464-410X.2008.07920.x","article-title":"The destruction of the lower urinary tract by ketamine abuse: A new syndrome?","volume":"102","author":"Chu","year":"2008","journal-title":"BJU Int."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"810","DOI":"10.1016\/j.urology.2007.01.038","article-title":"Ketamine-associated ulcerative cystitis: A new clinical entity","volume":"69","author":"Shahani","year":"2007","journal-title":"Urology"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1136\/postgradmedj-2013-131776","article-title":"Evaluation of the extent of ketamine-induced uropathy: The role of CT urography","volume":"90","author":"Huang","year":"2014","journal-title":"Postgrad. Med. J."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1007\/s10157-017-1463-0","article-title":"Importance of glomerular filtration rate change as surrogate endpoint for the future incidence of end-stage renal disease in general Japanese population: Community-based cohort study","volume":"22","author":"Kanda","year":"2018","journal-title":"Clin. Exp. Nephrol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1053\/j.ajkd.2019.06.009","article-title":"Change in albuminuria and GFR as end points for clinical trials in early stages of CKD: A scientific workshop sponsored by the National Kidney Foundation in collaboration with the US Food and Drug Administration and European Medicines Agency","volume":"75","author":"Levey","year":"2020","journal-title":"Am. J. Kidney Dis."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1159\/000338098","article-title":"Ketamine-associated urinary tract dysfunction: An underrecognized clinical entity","volume":"89","author":"Lai","year":"2012","journal-title":"Urol. Int."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"826","DOI":"10.1111\/j.1442-2042.2009.02361.x","article-title":"Ketamine-associated bladder dysfunction","volume":"16","author":"Tsai","year":"2009","journal-title":"Int. J. Urol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"816","DOI":"10.1111\/iju.12841","article-title":"Possible pathophysiology of ketamine-related cystitis and associated treatment strategies","volume":"22","author":"Jhang","year":"2015","journal-title":"Int. J. Urol."},{"key":"ref_19","first-page":"341","article-title":"Genitourinary toxicity of ketamine","volume":"1919","author":"Wei","year":"2013","journal-title":"Hong Kong Med. J."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Jiang, Y.H., Liu, H.T., and Kuo, H.C. (2014). Decrease of urinary nerve growth factor but not brain-derived neurotrophic factor in patients with interstitial cystitis\/bladder pain syndrome treated with hyaluronic acid. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0091609"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1249","DOI":"10.1016\/j.juro.2014.05.084","article-title":"Elevated serum IgE may be associated with development of ketamine cystitis","volume":"192","author":"Jhang","year":"2014","journal-title":"J. Urol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"128","DOI":"10.5213\/inj.1732704.352","article-title":"The risk of upper urinary tract involvement in patients with ketamine-associated uropathy","volume":"21","author":"Yee","year":"2017","journal-title":"Int. Neurourol. J."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1136\/jcp.2010.087171","article-title":"Ureteric intestinal metaplasia in association with chronic recreational ketamine abuse","volume":"64","author":"Hopcroft","year":"2011","journal-title":"J. Clin. Pathol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1111\/j.1757-5672.2011.00101.x","article-title":"Ketamine-induced uropathy: A new clinical entity causing lower urinary tract symptoms","volume":"4","author":"Chang","year":"2012","journal-title":"Low Urin. Tract Symptoms"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"833","DOI":"10.1111\/j.1442-2042.2007.01834.x","article-title":"Effect of exogenous glutamate and N-Methyl-D-aspartic acid on spontaneous activity of isolated human ureter","volume":"14","author":"Jankovic","year":"2007","journal-title":"Int. J. Urol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1111\/j.1742-1241.2010.02502.x","article-title":"Ketamine-induced vesicopathy: A literature review","volume":"65","author":"Middela","year":"2011","journal-title":"Int J. Clin. Pract."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1016\/j.urology.2015.05.003","article-title":"Clinical outcome of a prospective case series of patients with ketamine cystitis who underwent standardized treatment protocol","volume":"86","author":"Yee","year":"2015","journal-title":"Urology"},{"key":"ref_28","first-page":"53","article-title":"Dilated common bile ducts mimicking choledochal cysts in ketamine abusers","volume":"15","author":"Wong","year":"2009","journal-title":"Hong Kong Med. J."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1759","DOI":"10.1016\/j.cgh.2014.01.041","article-title":"Liver injury is common among chronic abusers of ketamine","volume":"12","author":"Wong","year":"2014","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_30","first-page":"e52","article-title":"Cholestasis and biliary dilatation associated with chronic ketamine abuse: A case series","volume":"52","author":"Lo","year":"2011","journal-title":"Singapore Med. J."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/19\/7260\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T10:16:30Z","timestamp":1760177790000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/19\/7260"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,10,4]]},"references-count":30,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2020,10]]}},"alternative-id":["ijerph17197260"],"URL":"https:\/\/doi.org\/10.3390\/ijerph17197260","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,10,4]]}}}