Abstract

TORREGROSA, José-Vicente  and  RAMOS, Ana María. Use of bisphosphonates in chronic kidney disease. Nefrología (Madr.) [online]. 2010, vol.30, n.3, pp.288-296. ISSN 1989-2284.

Bisphosphonates are synthetic compounds similar to organic pyrophosphates. The bioavailability of intravenous preparations is 100%, whereas the availability of oral therapy ranges from 1 to 5%. About 50% to 80% of free bisphosphonates are incorporated into the bone. Because of their urinary elimination, bisphosphonates must be carefully administered in chronic kidney disease (CKD) patients. In spite of this, bisphosphonates can safely be used at all CKD stages, including dialysis and kidney transplant. 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. In patients with CKD, it is very relevant to maintain infusion time and in haemodialysis patients we recommend administration during the haemodialysis session. When bisphosphonates are given to 4-5 CKD patients it seems reasonable to reduce the dose to 50%. No renal pathology has been associated to oral administration. The indications of bisphosphonates in CKD include: hypercalcaemia episodes, preventing bone loss after renal transplantation, treating low bone mineral density in all CKD stages including transplantation. They are too a promising therapy for calciphylaxis and to prevent vascular calcifications. When suppressed bone turnover is suspected, bone biopsy is mandatory before bisphosphonates therapy.

Keywords : Bisphosphonates; Chronic Renal disease.

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