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Bisphosphonate use in patients undergoing dialysis
Scott Martin Vouri1, Amie Taggart Blaszczyk
1Saint Louis College of Pharmacy, St. Louis, Missouri.
Summary
Bisphosphonates effectively treat osteoporosis and fractures. However, limited data exist on their use in dialysis patients, necessitating further research before routine recommendation.
Area of Science:
- Nephrology
- Pharmacology
- Orthopedics
Background:
- Osteoporosis is prevalent in dialysis patients (13-80%).
- Bisphosphonates are effective antiosteoporotic agents.
- Limited data exist on bisphosphonate use in patients undergoing dialysis.
Purpose of the Study:
- To review the available literature on bisphosphonates and dialysis.
- To discuss factors influencing bisphosphonate use in dialysis patients.
Main Methods:
- Literature review of bisphosphonates and dialysis.
- Analysis of pharmacokinetic considerations for bisphosphonate use in renal impairment.
Main Results:
- Bisphosphonates are renally cleared, suggesting contraindication in dialysis patients.
- Factors like drug removal, molecular weight, protein binding, and dialysis parameters influence efficacy.
- Much data are from non-osteoporosis studies.
Conclusions:
- Dialysis patients may benefit from bisphosphonates due to high osteoporosis risk.
- More data are needed to establish safe and effective bisphosphonate use in this population.
- Routine recommendation is not yet supported due to knowledge gaps.
Keywords:
BMD = Bone mineral densityBisphosphonateCKD = Chronic kidney diseaseChronic kidney diseaseDialysisEnd-stage kidney diseaseIV = IntravenousKDIGO = Kidney Disease: Improving Global OutcomesKUf = Ultrafiltration coefficientOsteoporosisPTH = Parathyroid hormoneRANK = Receptor activator of nuclear factor kappa-BRenaleClcr = Estimated creatinine clearance
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