Articles producció científica> Ciències Mèdiques Bàsiques

Oral Bisphosphonate Use and All-Cause Mortality in Patients With Moderate-Severe (Grade 3B-5D) Chronic Kidney Disease: A Population-Based Cohort Study

  • Dades identificatives

    Identificador: imarina:6120837
    Handle: https://hdl.handle.net/20.500.11797/imarina6120837
    Autors:
    Prieto-Alhambra DJavaid MKCooper CJudge ACenter JRPérez-Sáez MJPascual JDiez-Perez AAbrahamsen BBen-Shlomo YArden NKCaskey FJElhussein LTebe CPallares NBliuc DAli MSAlarkawi D
    Resum:
    Oral bisphosphonates (oBPs) have been associated with reduced fractures and mortality. However, their risks and benefits are unclear in patients with moderate-severe CKD. This study examined the association between oBPs and all-cause mortality in G3B-5D CKD. This is a population-based cohort study including all subjects with an estimated glomerular filtration rate (eGFR) <45/mL/min/1.73 m(2) (G3B: eGFR <45/mL/min/1.73 m(2) G4: eGFR 15-29/mL/min/1.73 m(2) G5: eGFR <15/mL/min/1.73 m(2) G5D: hemodialysis) aged 40+ years from the UK Clinical Practice Research Datalink (CPRD) and the Catalan Information System for Research in Primary Care (SIDIAP). Previous and current users of other anti-osteoporosis drugs were excluded. oBP use was modeled as a time-varying exposure to avoid immortal time bias. Treatment episodes in oBP users were created by concatenating prescriptions until patients switched or stopped therapy or were censored or died. A washout period of 180 days was added to (date of last prescription +180 days). Propensity scores (PSs) were calculated using prespecified predictors of mortality including age, gender, baseline eGFR, socioeconomic status, comorbidities, previous fracture, co-medications, and number of hospital admissions in the previous year. Cox models were used for PS adjustment before and after PS trimming (the first and last quintiles). In the CPRD, of 19,351 oBP users and 210,954 non-oBP users, 5234 (27%) and 85,105 (40%) deaths were recorded over 45,690 and 915,867 person-years of follow-up, respectively. oBP users had 8% lower mortality risk compared to non-oBP users (hazard ratio [HR] 0.92; 95% CI, 0.89 to 0.95). Following PS trimming, this became nonsignificant (HR 0.98; 95% CI, 0.94 to 1.04). In the SIDIAP, of 4146 oBP users and 86,127 non-oBP u

  • Altres:

    Autor segons l'article: Prieto-Alhambra D Javaid MK Cooper C Judge A Center JR Pérez-Sáez MJ Pascual J Diez-Perez A Abrahamsen B Ben-Shlomo Y Arden NK Caskey FJ Elhussein L Tebe C Pallares N Bliuc D Ali MS Alarkawi D
    Departament: Ciències Mèdiques Bàsiques
    Autor/s de la URV: TEBÉ CORDOMÍ, CRISTIAN
    Paraules clau: Zoledronic Acid Women SUBSEQUENT FRACTURE Safety Renal-Function Osteoporosis Mortality Men Increased Risk Hip Fracture Epidemiology Denosumab Chronic Kidney Disease BONE-DISEASE Bisphosphonates Mortality epidemiology Chronic kidney disease Bisphosphonates
    Resum: Oral bisphosphonates (oBPs) have been associated with reduced fractures and mortality. However, their risks and benefits are unclear in patients with moderate-severe CKD. This study examined the association between oBPs and all-cause mortality in G3B-5D CKD. This is a population-based cohort study including all subjects with an estimated glomerular filtration rate (eGFR) <45/mL/min/1.73 m(2) (G3B: eGFR <45/mL/min/1.73 m(2) G4: eGFR 15-29/mL/min/1.73 m(2) G5: eGFR <15/mL/min/1.73 m(2) G5D: hemodialysis) aged 40+ years from the UK Clinical Practice Research Datalink (CPRD) and the Catalan Information System for Research in Primary Care (SIDIAP). Previous and current users of other anti-osteoporosis drugs were excluded. oBP use was modeled as a time-varying exposure to avoid immortal time bias. Treatment episodes in oBP users were created by concatenating prescriptions until patients switched or stopped therapy or were censored or died. A washout period of 180 days was added to (date of last prescription +180 days). Propensity scores (PSs) were calculated using prespecified predictors of mortality including age, gender, baseline eGFR, socioeconomic status, comorbidities, previous fracture, co-medications, and number of hospital admissions in the previous year. Cox models were used for PS adjustment before and after PS trimming (the first and last quintiles). In the CPRD, of 19,351 oBP users and 210,954 non-oBP users, 5234 (27%) and 85,105 (40%) deaths were recorded over 45,690 and 915,867 person-years of follow-up, respectively. oBP users had 8% lower mortality risk compared to non-oBP users (hazard ratio [HR] 0.92; 95% CI, 0.89 to 0.95). Following PS trimming, this became nonsignificant (HR 0.98; 95% CI, 0.94 to 1.04). In the SIDIAP, of 4146 oBP users and 86,127 non-oBP users, 1330 (32%) and 36,513 (42%) died, respectively. oBPs were not associated with mortality in PS adjustment and trimming (HR 1.04; 95% CI, 0.99 to 1.1 and HR 0.95; 95% CI, 0.89 to 1.01). In this observational, patient-based cohort study, oBPs were not associated with increased mortality among patients with moderate-severe CKD. However, further studies are needed on other effects of oBPs in CKD patients. (c) 2020 American Society for Bone and Mineral Research (c) 2020 American Society for Bone and Mineral Research.
    Àrees temàtiques: Orthopedics and Sports Medicine Endocrinology, Diabetes and Metabolism Endocrinology & Metabolism
    Accès a la llicència d'ús: https://creativecommons.org/licenses/by/3.0/es/
    Adreça de correu electrònic de l'autor: cristian.tebe@urv.cat
    ISSN: 08840431
    Identificador de l'autor: 0000-0003-2320-1385
    Data d'alta del registre: 2020-07-22
    Versió de l'article dipositat: info:eu-repo/semantics/acceptedVersion
    Referència a l'article segons font original: JOURNAL OF BONE AND MINERAL RESEARCH. (ISSN/ISBN: 08840431). 35(5): 894-900
    Referència de l'ítem segons les normes APA: Alarkawi D, Ali MS, Bliuc D, Pallares N, Tebe C, Elhussein L, Caskey FJ, Arden NK, Ben-Shlomo Y, Abrahamsen B, Diez-Perez A, Pascual J, Pérez-Sáez MJ, Center JR, Judge A, Cooper C, Javaid MK, Prieto-Alhambra D (2020). Oral Bisphosphonate Use and All-Cause Mortality in Patients With Moderate-Severe (Grade 3B-5D) Chronic Kidney Disease: A Population-Based Cohort Study. JOURNAL OF BONE AND MINERAL RESEARCH, (), -. DOI: 10.1002/jbmr.3961
    URL Document de llicència: https://repositori.urv.cat/ca/proteccio-de-dades/
    Entitat: Universitat Rovira i Virgili
    Any de publicació de la revista: 2020
    Tipus de publicació: Journal Publications

  • Paraules clau:

    Endocrinology & Metabolism,Endocrinology, Diabetes and Metabolism,Orthopedics and Sports Medicine
    Zoledronic Acid
    Women
    SUBSEQUENT FRACTURE
    Safety
    Renal-Function
    Osteoporosis
    Mortality
    Men
    Increased Risk
    Hip Fracture
    Epidemiology
    Denosumab
    Chronic Kidney Disease
    BONE-DISEASE
    Bisphosphonates
    Mortality
    epidemiology
    Chronic kidney disease
    Bisphosphonates
    Orthopedics and Sports Medicine
    Endocrinology, Diabetes and Metabolism
    Endocrinology & Metabolism
    08840431

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