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Bones and Kidneys and Bisphosphonates… OH MY!

Bones and Kidneys and Bisphosphonates… OH MY!. Sandra Katalinic. PICO Question.

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Bones and Kidneys and Bisphosphonates… OH MY!

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  1. Bones and Kidneys and Bisphosphonates… OH MY! Sandra Katalinic

  2. PICO Question • In a 73 year old female with osteoporosis, Paget’s disease, and chronic kidney failure (CrCl ≈ 10ml/min), what is the safe and effective recommended dose of alendronate for the treatment of pain and slowing progression of bony growths secondary to Paget's disease as compared to a patient with normally functioning kidneys (CrCl ≥60ml/min)?

  3. Search Strategy • DiPiro, Up-to-date, CPS • PubMed, Google, First Consult • Merck-Frosst “help-line” • Search Terms: alendronate, Fosamax, Paget’s disease, kidney failure, kidney disease, dialysis, hemodialysis.

  4. Findings • Regular Paget’s Dosing • 40mg PO daily x 6 months  reassess • Dosing in dialysis • Bisphosphonates contraindicated for use in patients with kidney dysfunction (CrCl < 35ml/min) or those on dialysis • Alendronate / bisphosphonates not removed by dialyzing fluid • Vd = 2576L ; 78% protein bound • No well studied recommended dose in this population

  5. However…. • Paget’s Disease of Bone in a Patient on Hemodialysis – Iranian Journal of Kidney Disease (Apr. 2008) • Case study of 77 y/o female w/ Paget's and on hemodialysis (ESRD) • Given 70mg alendronate q week x 6mo • Reassessed and symptom free, AlkPhos normalized (30-120U/L) • Hemo-clinic 35mg twice weekly  reassess in 3 mo • Pain, bony growth / remodeling, AlkPhos

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