Backgound: The clinical course of multiple myeloma is often associated with significant bone related morbidity. This can be modified by the use of bisphosphonates. Studies have shown renal toxicity associated with different bisphosphonates especially following the exposure of zoledronic acid. Published literature suggests renal function deterioration occurs in 8.8–15.2% of patients at recommended dose of 4 mg infused intravenously over 15 minutes.

Methods: We retrospectively reviewed the records of all patients with multiple myeloma who received bisphosphonates during the period of January 2002-June 2004 at our institution. 114 patients were analyzed (male/female 63/51; age-median 69;mean 71;range 40–92). 61 (54%) were >70 years of age. They received a total of 1301 doses (mean 11.4) during this period. The type of bisphosphonate used was: zolendronate: 58; pamidronate: 23; pamidronate changed to zolendronate (both) : 33. Patients were categorized to the type and sequence of bisphosphonates [ pamidronate vs. zoledronate and pamidronate followed by zoledronate (both) ], age and sex. Renal dysfunction was defined as an increase in serum creatinine of >0.5 mg/dl over baseline.

Results: There were 19 patients (16.7%) who developed renal dysfunction. 15 of the 19 episodes (79%) occurred in the 70 years and older group. The table shows the distribution of patients, type of bisphosphonate and the distribution of patients with renal toxicity.

Conclusion: This analysis showed increase in renal dysfunction occurs in all ages with use of bisphosphonates. The elderly may be particularly susceptible to this toxicity. Although we have not analyzed the impact of associated comorbidities (including type of multiple myeloma) leading to renal insufficiency in this study, the elderly patients may need more close monitoring of renal function with the use of bisphosphonates.

Age and renal impairment with bisphosphonate use

AgeZolendronatePamidronateBothTotal
Number in paranthesis indicates the renal impairment case 
40–49 6 (0) 2 (0) 2 (0) 10 (0) 
50–59 10 (0) 1 (0) 4 (0) 15 (0) 
60–69 14 (2) 3 (0) 11 (1) 28(3) 
70–79 19 (3) 9 (1) 14 (4) 42 (8) 
80+ 9 (3) 8 (0) 2 (4) 19 (7) 
Total 58 (9) 23 (1) 33 (9) 114 (19) 
AgeZolendronatePamidronateBothTotal
Number in paranthesis indicates the renal impairment case 
40–49 6 (0) 2 (0) 2 (0) 10 (0) 
50–59 10 (0) 1 (0) 4 (0) 15 (0) 
60–69 14 (2) 3 (0) 11 (1) 28(3) 
70–79 19 (3) 9 (1) 14 (4) 42 (8) 
80+ 9 (3) 8 (0) 2 (4) 19 (7) 
Total 58 (9) 23 (1) 33 (9) 114 (19) 
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Topics:
bisphosphonates, multiple myeloma, renal impairment, pamidronate, kidney failure, zoledronic acid, nephrotoxicity, toxic nephropathy, creatinine tests, serum, select the dosage, dosage form or route of administration
2005, The American Society of Hematology
2004
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