The Issue of Renal Safety of Zoledronic Acid from a Nephrologist's Point of View

Balla, József

doi:10.1634/theoncologist.10-5-306

Cited by 23 publications

(15 citation statements)

References 20 publications

(1 reference statement)

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“…17 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 Chronic Kidney Disease (CKD), multiple myeloma, hypercalcaemia, hypertension, diabetes mellitus, advanced age, chemotherapy or previous treatment with a bisphosphonate. 16,18 Important factors which may increase renal toxicity of the intravenous bisphosphonates are higher dose, shorter infusion times or dose interval lower than recommended. 16,19 The total dose of the drug which has been administered during a long-term treatment may also play a role because of its probable cumulative effect.…”

Section: Ocular Adverse Eventsmentioning

confidence: 99%

Bisphosphonate-associated adverse events

Papapetrou

2009

253

174

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The adverse events of the nitrogen-containing bisphosphonates are reviewed. Oral bisphosphonates (alendronate, risedronate and ibandronate), mainly used for the treatment of osteoporosis, have been associated with adverse events from the upper gastrointestinal tract, acute phase response, hypocalcaemia and secondary hyperparathyroidism, musculoskeletal pain, osteonecrosis of the jaw and ocular events. Intravenous bisphosphonates (pamidronate, ibandronate and zoledronic acid), used in oncology and for the treatment of osteoporosis, have been associated with all the above adverse events, except those from the upper gastrointestinal tract. Moreover, pamidronate and zoledronic acid have been associated with renal toxicity. Association of bisphosphonates with atrial fibrillation and atypical fractures of the femoral diaphysis remains uncertain. There are a few case reports relating bisphosphonates to cutaneous reactions, oral ulcerations, hepatitis and esophageal cancer. Generally, intravenous are more potent than oral bisphosphonates and the frequency and severity of some of the bisphosphonate-associated adverse events are dose and potency dependent.

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Section: Ocular Adverse Eventsmentioning

confidence: 99%

Bisphosphonate-associated adverse events

Papapetrou

2009

253

174

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“…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]. The total dose of the drug which has been administered during a long-term treatment may also play a role because of its probable cumulative effect [25].…”

Section: Introductionmentioning

confidence: 99%

Use of Bisphosphonates in Chronic Kidney Disease

Ozmen¹

2012

World J Nephrol Urol

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The primary goal of treatment for post-menopausal osteoporosis (PMO) is reduction in fracture risk. Therefore, bisphosphonates (BF) are the most commonly used drugs for the treatment of osteoporosis. Because of their urinary elimination, bisphosphonates must be carefully administered in chronic kidney disease (CKD) patients. Renal toxicity seems different among these compounds, and it is basically due to their protein binding and the average lifespan of renal tissues. In practice, renal toxicity has been associated with infusion speed and excessive dosage. Treatment decisions are more difficult with stage 4 and especially stage 5 CKD who had fragility fractures. In spite of this, bisphosphonates can safely be used at stage to 1 -3 CKD stages, haemodialysis and after the kidney transplant. When bisphosphonates are given stage 4 CKD patients it seems reasonable to reduce the dose to 50%. There are few data on the efficacy (reduction in fracture risk) or safety of any BF in patients with stage 5 CKD.

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“…However, a significant side-effect, although considered rare, associated with the use of zoledronic acid is renal toxicity [16Á18]. Nephrotoxicity is potentially life-threatening [19,20]. In the USA, Chang et al [21] highlighted 72 cases in which clinicians reported renal failure associated with zoledronic acid therapy to the Food and Drug Administration; 27 patients required dialysis, and 18 died.…”

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confidence: 99%