Boise Veterans Affairs Medical Center, Pharmacy, Boise, ID, USA.
University of Colorado - Anschutz Medical Campus, Pharmacy, Aurora, CO, USA.
Osteoporos Int. 2022 Nov;33(11):2417-2422. doi: 10.1007/s00198-022-06499-4. Epub 2022 Jul 13.
Our study examined renal function change in older adults with osteoporosis, treated with zoledronic acid. Risk of nephrotoxicity was low. Future studies are needed to evaluate use of zoledronic acid in patients with a CCr < 35 mL/min, as patients may be inappropriately excluded from its use.
Zoledronic acid (ZA) is used for the treatment of osteoporosis (OP). Renal impairment is a known risk factor for the rare occurrence of nephrotoxicity after ZA infusions, leading to use being contraindicated below creatinine clearance (CCr) of 35 mL/min. Our aims are to examine changes in serum creatinine (SCr) after infusions, capture frequency of acute kidney injury (AKI), and describe baseline kidney function estimates in adults 75 years and older being treated for OP.
This was a retrospective, cross-sectional, pre-post analysis that examined change in SCr before and after ZA infusions. The primary outcome was assessed using a paired Student t-test. Incidence of AKI within 1 year following infusions was noted and patient-specific factors were collected.
Five hundred fifty-eight ZA infusions in 327 patients met criteria. Mean SCr decreased by 0.01 mg/dL in the year following ZA infusions (p = 0.005). AKI occurred in 1.4% of patients and all had CCr > 45 mL/min. 4.5% of patients had CCr < 35 mL/min and none experienced an AKI.
There was no clinically relevant change in SCr after ZA infusions. Risk of nephrotoxicity was low and similar to risk seen in randomized trials occurring in younger patients. Kidney function estimates were dramatically lower using the Cockcroft-Gault (CG) equation in comparison to CKD-EPI. We believe use of the CG equation in this population may be inappropriately limiting our ability to use ZA for treatment of OP in older adults but more evidence is necessary.
我们的研究考察了接受唑来膦酸治疗的老年骨质疏松症患者的肾功能变化。肾毒性风险较低。需要进一步的研究来评估在 CCr<35ml/min 的患者中使用唑来膦酸的情况，因为患者可能被不适当地排除在其使用之外。
唑来膦酸（ZA）用于治疗骨质疏松症（OP）。肾功能损害是 ZA 输注后罕见发生肾毒性的已知危险因素，导致其在肌酐清除率（CCr）<35ml/min 时被禁用。我们的目的是检查输注后血清肌酐（SCr）的变化，捕捉急性肾损伤（AKI）的频率，并描述接受 OP 治疗的 75 岁及以上成年人的基线肾功能估计值。
这是一项回顾性、横断面、前后对照分析，检查了 ZA 输注前后 SCr 的变化。主要结果采用配对学生 t 检验进行评估。注意输注后 1 年内 AKI 的发生率，并收集患者的具体因素。
327 例患者中有 558 例 ZA 输注符合标准。ZA 输注后 1 年内 SCr 平均下降 0.01mg/dL（p=0.005）。1.4%的患者发生 AKI，所有患者的 CCr>45ml/min。4.5%的患者 CCr<35ml/min，无一例发生 AKI。
ZA 输注后 SCr 无临床相关变化。肾毒性风险较低，与在较年轻患者中进行的随机试验中的风险相似。与 CKD-EPI 相比，使用 Cockcroft-Gault（CG）方程估算肾功能的结果明显较低。我们认为在该人群中使用 CG 方程可能不适当地限制了我们在老年患者中使用 ZA 治疗 OP 的能力，但需要更多的证据。
