Kidney Week

Abstract: FR-PO164

Oral Bisphosphonate Use and Renal Function Decline in Patients with CKD

Session Information

• CKD: Epidemiology, Risk Factors, Prevention - II
  October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 1901 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

• Caskey, Fergus J., Southmead Hospital, Bristol, United Kingdom

Fergus J. Caskey,

• Robinson, Danielle E., University of Oxford, Oxford, United Kingdom

Danielle E. Robinson,

• Strauss, Victoria Y., University of Oxford, Oxford, United Kingdom

Victoria Y. Strauss,

• Ali, M sanni, London School of hygiene and tropical medicine, London, United Kingdom

M sanni Ali,

• Cooper, Cyrus, MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom

Cyrus Cooper,

• Ben-shlomo, Yoav, School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom

Yoav Ben-shlomo,

• Abrahamsen, Bo, University of Southern Denmark, Odense, Denmark

Bo Abrahamsen,

• Delmestri, Antonella, University of Oxford, Oxford, United Kingdom

Antonella Delmestri,

• Judge, Andrew, University of Oxford, Oxford, United Kingdom

Andrew Judge,

• Javaid, Muhammad K., University of Oxford, Oxford, United Kingdom

Muhammad K. Javaid,

• Prieto-Alhambra, Daniel, University of Oxford, Oxford, United Kingdom

Daniel Prieto-Alhambra,

Background

Oral bisphosphonates (BP) are contraindicated in patients with moderate-severe chronic kidney disease (CKD) due to concerns regarding their effects on renal function. The aim of this study was to assess the effect of BP use on CKD stage worsening and annual changes in estimated glomerular filtration rate (eGFR) over time.

Methods

Patients aged 40+ with an eGFR<45 in UK primary care (CPRD) linked to hospital records. Followed for up to 10 years. BP users censored 210 days after the last BP prescription. Unexposed patients could become exposed; 10-year follow up re-started.
Users were matched to up to 5 non-users using propensity scores (PS), stratified by the number of years of follow-up. Cox regression was used to estimate the hazard ratio (HR) of stage worsening. The rates of annual eGFR changes were estimated by the slopes of a mixed effect model with cubic splines and an interaction between BP use and time.

Results

31275 patients (6309 BP users) were included in the PS matched analyses. 3,978 (13%) patients moved to a later stage. The HR for BP users was 1.69 (95% confidence interval (CI): 1.58, 1.80). Annual eGFR changes were different for BP users and non-users (Figure). In the first three years, the mean eGFR increased at the rate of 2.58 (2.50, 2.66) and 0.91 (0.65, 1.17) mL/min/1.73 m^2 per year for non-users and users, respectively. They were followed by slow decline slopes of -0.80 (-0.89, -0.70) and -0.24 (-0.55, 0.08) per year. No significant difference in mean eGFR after 8 years.

Conclusion

BP use has a 70% higher likelihood of worsening in CKD stages. Further research is needed to understand the longitudinal changes in eGFR trajectories.

Funding

• Government Support - Non-U.S.