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What are the dosing recommendations and indications for use of bisphosphonates in states of kidney injury?
In general, most of the data for the use of bisphosphonates in patients with varying degrees of Acute Kidney Injruy have come from trials looking at treatment of hypercalcemia associated with multiple myeloma and other malignancies.
Metabolic changes in bone morphology associated with Chronic Kidney Disease complicate the definition of osteoporosis and thus the validity of the indication for these therapies in this population.
Dosing Recommendations for Bisphosphonates in Kidney Injury
HYPERCALCEMIA IN ACUTE KIDNEY INJURY | CHRONIC KIDNEY DISEASE STAGES 3–5 | HEMODIALYSIS | |
|---|---|---|---|
| Pamidronate (Avedia) | OK | Avoid—associated with development of focal segmental glomerulosclerosis | OK—for 1 dose of 30 mg if failing other therapies |
| Alendronate (Fosamax) | — | Avoid in glomerular filtration rate <30–35 | Avoid |
| Ibandronate (Boniva) | OK | Avoid | |
| Risedronate (Actonel) | — | Avoid | |
| Zoledronic acid (Zometa) | Use with caution | Avoid | Avoid |
