TY - JOUR
T1 - Oral bisphosphonate use in the elderly is not associated with acute kidney injury
AU - Shih, Andrew W.Y.
AU - Weir, Matthew A.
AU - Clemens, Kristin K.
AU - Yao, Zhan
AU - Gomes, Tara
AU - Mamdani, Muhammad M.
AU - Juurlink, David N.
AU - Hird, Amanda
AU - Hodsman, Anthony
AU - Parikh, Chirag R.
AU - Wald, Ron
AU - Cadarette, Suzanne M.
AU - Garg, Amit X.
N1 - Funding Information:
SMC is supported by a Canadian Institutes of Health Research (CIHR) New Investigator Award in the Area of Aging and Osteoporosis, and an Ontario Ministry of Research and Innovation Early Researcher Award. RW is supported by the Randomized Controlled Trial Mentoring Program of CIHR. AXG is supported by a CIHR Clinician Scientist Award. MMM was a previous employee with Amgen, Astra Zeneca, Pfizer, BI, Lilly, and Novo Nordisk.
Funding Information:
This project was supported by research funds from the Ontario Drug Policy Research Network and by the Institute for Clinical Evaluative Sciences (ICES), which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). The sponsors had no role in the design and conduct of the study; in the collection, analysis, and interpretation of the data; or in the preparation, review, or approval of the manuscript. The opinions, results, and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred. We thank Brogan Inc., Ottawa for use of its Drug Product and Therapeutic Class Database. We thank the late Dr Milton Haines, Ms Barbara Jones, Mr Jeff Lamond and others from Gamma Dynacare for their use of the outpatient laboratory database. We thank Mr Glen Kearns from the London Health Sciences Centre who facilitated the use of linked hospital laboratory databases. We thank Dr Salimah Shariff for her help with some of the analysis.
PY - 2012/10/2
Y1 - 2012/10/2
N2 - Intravenous bisphosphonates can cause acute kidney injury; however, this risk was not found with oral bisphosphonates in randomized clinical trials with restrictive eligibility criteria. In order to provide complementary safety data, we studied the risk of acute kidney injury in a population-based cohort of 122,727 patients aged 66 years and older discharged from hospital following a new fragility fracture and no history of bisphosphonate use in the prior year. Bisphosphonate treatment was identified within 120 days after discharge and event rates were measured from 90 days of therapy initiation. The primary outcome was hospitalization with acute kidney injury with secondary outcomes of new nephrology consultation and, in a subset of patients with laboratory values, acute kidney injury was defined as an increase in serum creatinine. We identified 18,286 bisphosphonate users and 104,441 non-users with a mean age of 81 years. Of 5772 patients with laboratory values, 40% had chronic kidney disease (eGFR 60 ml/min per 1.73 m 2). Overall, there was no statistically significant difference in the risk of acute kidney injury among bisphosphonate users compared to non-users (adjusted odds ratio 1.03), and no significant differences in other outcomes or in subgroups of patients with baseline chronic kidney disease. Thus, in this older population-based cohort, oral bisphosphonate use was not associated with acute kidney injury.
AB - Intravenous bisphosphonates can cause acute kidney injury; however, this risk was not found with oral bisphosphonates in randomized clinical trials with restrictive eligibility criteria. In order to provide complementary safety data, we studied the risk of acute kidney injury in a population-based cohort of 122,727 patients aged 66 years and older discharged from hospital following a new fragility fracture and no history of bisphosphonate use in the prior year. Bisphosphonate treatment was identified within 120 days after discharge and event rates were measured from 90 days of therapy initiation. The primary outcome was hospitalization with acute kidney injury with secondary outcomes of new nephrology consultation and, in a subset of patients with laboratory values, acute kidney injury was defined as an increase in serum creatinine. We identified 18,286 bisphosphonate users and 104,441 non-users with a mean age of 81 years. Of 5772 patients with laboratory values, 40% had chronic kidney disease (eGFR 60 ml/min per 1.73 m 2). Overall, there was no statistically significant difference in the risk of acute kidney injury among bisphosphonate users compared to non-users (adjusted odds ratio 1.03), and no significant differences in other outcomes or in subgroups of patients with baseline chronic kidney disease. Thus, in this older population-based cohort, oral bisphosphonate use was not associated with acute kidney injury.
UR - http://www.scopus.com/inward/record.url?scp=84867089856&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84867089856&partnerID=8YFLogxK
U2 - 10.1038/ki.2012.227
DO - 10.1038/ki.2012.227
M3 - Article
C2 - 22695327
AN - SCOPUS:84867089856
SN - 0085-2538
VL - 82
SP - 903
EP - 908
JO - Kidney International
JF - Kidney International
IS - 8
ER -