Use of bisphosphonates in chronic kidney disease is associated with cardiovascular death.

IF 1.1 4区 医学 Q3 UROLOGY & NEPHROLOGY
Kathleen A Borghoff, Agnes E Ounda, Melissa L Swee, Saket Girotra, Amal A Shibli-Rahhal, Patrick Ten Eyck, Diana I Jalal, Anna J Jovanovich
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引用次数: 0

Abstract

Background and objectives: Chronic kidney disease (CKD) is associated with increased cardiovascular risk, which may be mediated by vascular calcification. Based on evidence that bisphosphonates inhibit vascular calcification, we hypothesized use of bisphosphonates in CKD would be associated with lower incident cardiovascular disease (CVD), CVD-related mortality, and all-cause mortality.

Materials and methods: This was a longitudinal observational study including 2,593 Framingham Offspring participants. We used propensity score-adjusted Cox regression models to determine the association between bisphosphonate use and outcomes: time to incident CVD, time to CVD-related mortality, and time to all-cause mortality. The data were stratified by presence or absence of CKD, defined as estimated glomerular filtration rate < 60 mL/min/1.73m2. The propensity score included age, sex, hypertension, smoking status, diabetes, total cholesterol, high-density lipoprotein, and self-reported history of fracture.

Results: In unadjusted and propensity score-adjusted analyses, those with CKD using bisphosphonates had a trend toward increased incident CVD risk (adjusted hazard ratio (HR) 1.66 (95% CI, 93 - 2.97)) compared to those with CKD not using bisphosphonates. Those with CKD using bisphosphonates also had increased risk of cardiovascular mortality in the propensity score-adjusted model (adjusted HR 2.20 (95% CI, 1.12 - 4.32)). There was no significant association between bisphosphonate use and all-cause mortality in participants with CKD. Among individuals without CKD, bisphosphonate use was significantly associated with an increase in all-cause mortality in the propensity-score adjusted analysis (adjusted HR 1.59 (95% CI, 1.27 - 1.98)). However, there was no significant association between bisphosphonate use and incident CVD events (adjusted HR 0.85 95% CI, 0.63 - 1.16) or CVD-related death (adjusted HR 0.70 (95% CI 0.36 - 1.37) in those without CKD.

Conclusion: Contrary to our hypothesis, bisphosphonate use was associated with a trend toward increased incident CVD and a two-fold higher risk of CVD mortality in CKD.

慢性肾病患者使用双膦酸盐与心血管死亡有关。
背景和目的:慢性肾脏病(CKD)与心血管风险增加有关,而心血管风险可能是由血管钙化介导的。基于双膦酸盐抑制血管钙化的证据,我们假设在 CKD 患者中使用双膦酸盐会降低心血管疾病(CVD)的发病率、CVD 相关死亡率和全因死亡率:这是一项纵向观察研究,包括 2,593 名弗雷明汉后代研究参与者。我们使用倾向得分调整后的 Cox 回归模型来确定双膦酸盐的使用与以下结果之间的关联:心血管疾病发病时间、心血管疾病相关死亡率和全因死亡率。数据按是否患有慢性肾脏病(定义为估计肾小球滤过率2)进行分层。倾向评分包括年龄、性别、高血压、吸烟状况、糖尿病、总胆固醇、高密度脂蛋白和自我报告的骨折史:在未经调整和倾向得分调整的分析中,与未使用双膦酸盐的 CKD 患者相比,使用双膦酸盐的 CKD 患者发生心血管疾病的风险呈上升趋势(调整后的危险比 (HR) 为 1.66 (95% CI, 93 - 2.97))。在倾向得分调整模型中,使用双膦酸盐的 CKD 患者的心血管死亡风险也有所增加(调整后危险比为 2.20 (95% CI, 1.12 - 4.32))。在患有慢性肾脏病的参试者中,使用双膦酸盐与全因死亡率之间没有明显关联。在无慢性肾脏病的人群中,根据倾向分数调整分析,使用双膦酸盐与全因死亡率的增加有显著相关性(调整后 HR 为 1.59 (95% CI, 1.27 - 1.98))。然而,在无慢性肾脏病的人群中,使用双膦酸盐与心血管疾病事件(调整HR 0.85 95% CI, 0.63 - 1.16)或心血管疾病相关死亡(调整HR 0.70 (95% CI 0.36 - 1.37))之间没有明显关联:与我们的假设相反,使用双膦酸盐与慢性肾脏病患者心血管疾病发病率增加和心血管疾病死亡风险增加两倍的趋势有关。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Clinical nephrology
Clinical nephrology 医学-泌尿学与肾脏学
CiteScore
2.10
自引率
9.10%
发文量
138
审稿时长
4-8 weeks
期刊介绍: Clinical Nephrology appears monthly and publishes manuscripts containing original material with emphasis on the following topics: prophylaxis, pathophysiology, immunology, diagnosis, therapy, experimental approaches and dialysis and transplantation.
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