Risk of renal impairment after treatment with ibandronate versus zoledronic acid: a retrospective medical records review

Abstract

In this retrospective review, patients were significantly more likely to experience renal impairment with zoledronic acid than with ibandronate.

Risk of renal failure in cancer patients with bone metastasis treated with renally adjusted zoledronic acid

“…Nordstrom and colleagues reported a 33% incidence of ARF in 33 patients receiving 4 mg of ZA with baseline SCr over 2.0 mg/dL [12]. Older age has been identified as a significant risk factor in our study, as well as in previously published studies [7]. Patients in the impaired group were significantly older than the normal group.…”

“…A review of the literature reveals an incidence of renal failure anywhere from 9% to 24% [1][2][3][7][8][9]. When the incidence of renal failure is evaluated based on a 25% decline in creatinine clearance (CrCl), it can reach up to 42-54% [7,8,10,11].…”

Use of Bisphosphonates in Chronic Kidney Disease

“…For instance, higher and repeated administration of zolendronic acid yielded renal histological abnormalities with the presence of degeneration and tubular atrophy, findings that were evident only with repeated doses of ibandronate [15,[17][18][19][20][21].…”

“…The renal toxicity of the intravenous bisphosphonates used in patients with malignant diseases involving bone is probably enhanced by risk factors for kidney function which may be present in these patients: pre-existing CKD, multiple myeloma, hypercalcaemia, hypertension, diabetes mellitus, advanced age, chemotherapy or previous treatment with a BF [15][16][17][18][19][20][21][22]. Important factors which may increase renal toxicity of the intravenous bisphosphonates are higher dose, shorter infusion times (< 15 ml/minute) or dose interval lower than recommended [15,23,24].…”

Osteoporosis in mineral and bone disorders of chronic kidney disease

“…On the other hand, multiple reports indicate safe use of these drugs in patients with multiple myeloma with severe bone resorption and kidney failure. 41,42 Ibadronate appears to be the safest bisphosphonate in patients with kidney failure, with the highest risk associated with zolendronic acid. Bisphosphonates, although potentially attractive in ESRD (may improve bone mineralization and reverse or decrease soft tissue calcification), should not be used in patients on dialysis because the nature of bone lesions cannot be predicted based on any lab test.…”