Safety of Oral Bisphosphonates in Patients With Moderate-to-severe CKD

Takeaway

• Bisphosphonate use was associated with a modest increase in the risk of chronic kidney disease (CKD) progression in patients with moderate-to-severe CKD (stage IIIb-V).
• No association was seen between bisphosphonate use and acute kidney injury, gastrointestinal (GI) events or hypocalcaemia.

Why this matters

• Bisphosphonates, which are currently contraindicated or used with caution in patients with an estimated glomerular filtration rate (eGFR) <30 mL/min/1.73m² should continue to be used with caution in this population.

Study design

• This study included patients with moderate-to-severe CKD (eGFR <45 mL/min/1.73m²; age, ≥40 years) from the UK Clinical Practice Research Datalink (CPRD; 1997-2016) and Catalonia’s Information System for the Development of Research in Primary Care (SIDIAP; 2007-2015).
• 2447 bisphosphonate users were propensity score matched with 8931 non-users from CPRD and 1399 users with 6547 non-users from SIDIAP.
• Primary outcome: CKD stage worsening.
• Funding: National Institute of Health Research Health Technology.

Key results

• Bisphosphonate use was associated with an increased risk of CKD progression in CPRD (HR, 1.14; 95% CI, 1.04-1.26) and SIDIAP (HR, 1.15; 95% CI, 1.04-1.27); combined HR, 1.14; 95% CI, 1.07-1.23.
• No risk differences were observed for:
  • acute kidney injury (combined HR, 0.92; 95% CI, 0.78-1.08);
  • GI bleeding/ulcers (combined HR, 0.97; 95% CI, 0.70-1.33); and
  • hypocalcaemia (HR, 0.34; 95% CI, 0.08-1.43) in CPRD.

Limitations

• Risk of confounding.

This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.