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Safety of Oral Bisphosphonates in Moderate-to-Severe Chronic Kidney Disease: A Binational Cohort Analysis
- Source :
- Robinson, D E, Ali, M S, Pallares, N, Tebé, C, Ben-Shlomo, Y, Caskey, F J, Judge, A, Prieto-Alhambra, D & al., E 2020, ' Safety of oral bisphosphonates in moderate-to-severe chronic kidney disease : a bi-national cohort analysis ', Journal of Bone and Mineral Research . https://doi.org/10.1002/jbmr.4235, Robinson, D E, Ali, M S, Pallares, N, Tebé, C, Elhussein, L, Abrahamsen, B, Arden, N K, Ben-Shlomo, Y, Caskey, F J, Cooper, C, Dedman, D, Delmestri, A, Judge, A, Pérez-Sáez, M J, Pascual, J, Nogues, X, Diez-Perez, A, Strauss, V Y, Javaid, M K & Prieto-Alhambra, D 2021, ' Safety of Oral Bisphosphonates in Moderate-to-Severe Chronic Kidney Disease : A Binational Cohort Analysis ', Journal of Bone and Mineral Research, vol. 36, no. 5, pp. 820-832 . https://doi.org/10.1002/jbmr.4235
- Publication Year :
- 2020
-
Abstract
- Bisphosphonates are the first-line treatment for preventing fractures in osteoporosis patients. However, their use is contraindicated or to be used with caution in chronic kidney disease (CKD) patients, primarily because of a lack of information about their safety and effectiveness. We aimed to investigate the safety of oral bisphosphonates in patients with moderate to severe CKD, using primary-care electronic records from two cohorts, CPRD GOLD (1997-2016) and SIDIAP (2007-2015) in the UK and Catalonia, respectively. Both databases were linked to hospital records. SIDIAP was also linked to end-stage renal disease registry data. Patients with CKD stages 3b to 5, based on two or more estimated glomerular filtration rate measurements less than 45 mL/min/1.73 m2 , aged 40 years or older were identified. New bisphosphonate users were propensity score-matched with up to five non-users to minimize confounding within this population. Our primary outcome was CKD stage worsening (estimated glomerular filtration rate [eGFR] decline or renal replacement therapy). Secondary outcomes were acute kidney injury, gastrointestinal bleeding/ulcers, and severe hypocalcemia. Hazard ratios (HRs) were estimated using Cox regression and Fine and Gray sub-HRs were calculated for competing risks. We matched 2447 bisphosphonate users with 8931 non-users from CPRD and 1399 users with 6547 non-users from SIDIAP. Bisphosphonate use was associated with greater risk of CKD progression in CPRD (sub-HR [95% CI]: 1.14 [1.04, 1.26]) and SIDIAP (sub-HR: 1.15 [1.04, 1.27]). No risk differences were found for acute kidney injury, gastrointestinal bleeding/ulcers, or hypocalcemia. Hence, we can conclude a modest (15%) increased risk of CKD progression was identified in association with bisphosphonate use. No other safety concerns were identified. Our findings should be considered before prescribing bisphosphonates to patients with moderate to severe CKD. © 2020 American Society for Bone and Mineral Research (ASBMR).
- Subjects :
- 0301 basic medicine
medicine.medical_specialty
Endocrinology, Diabetes and Metabolism
medicine.medical_treatment
Population
Osteoporosis
Renal function
030209 endocrinology & metabolism
Cohort Studies
antiresorptives
03 medical and health sciences
0302 clinical medicine
Risk Factors
Internal medicine
medicine
general population studies
Humans
Orthopedics and Sports Medicine
Renal replacement therapy
Renal Insufficiency, Chronic
education
education.field_of_study
Diphosphonates
business.industry
Hazard ratio
Acute kidney injury
Bisphosphonate
medicine.disease
osteoporosis
030104 developmental biology
statistical methods
fracture prevention
business
Kidney disease
Glomerular Filtration Rate
Subjects
Details
- ISSN :
- 15234681, 19972016, and 08840431
- Volume :
- 36
- Issue :
- 5
- Database :
- OpenAIRE
- Journal :
- Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral ResearchReferences
- Accession number :
- edsair.doi.dedup.....fd34f2941b6f9d0348fbb5a5c3158507