HDCN Article Review/Hyperlink

Machado CE, Flombaum CD

Safety of pamidronate in patients with renal failure and hypercalcemia

Clin Nephrol (Mar) 45:175-179 1996

Machado and Flombaum report the use of pamidronate in 31 patients with hypercalcemia of malignancy and serum creatinines ranging from 1.5 to 6.4 mg/dL. Patients received from 30 to 90 mg of intravenous pamidronate in normal saline over at least 24 hours. Serum creatinine remained unchanged or decreased in 25 patients. Four patients whose renal function decreased after pamidronate had multiple myeloma, Bence- Jones proteinuria, dehydration, and decreasing renal function before treatment with pamidronate. Other patients with worsening renal function during treatment had been given ibuprofen, ifosfamide, or had lower tract obstruction. The serum calcium decreased in all but one patient.

Comment: Pamidronate, a biphosphonate, inhibits osteoclast-mediated bone reabsorption and is used to treat the hypercalcemia of malignancy. A previous report of renal failure following rapid biphosphonate infusion and nephrotoxicity in animals given large doses has caused concern over the use of these drugs in patients with renal impairment. Machado and Flombaum report that the slow infusion of pamidronate given with saline hydration had little effect on renal function in most patients. Although possibly explained by other factors, nearly 20 per cent of the patients suffered a decrease in their renal function. Until larger groups are studied showing efficacy and safety, biphosphonates should be given with caution in patients with renal insufficiency. The authors recommendations for slow biphosphonate infusion and adequate hydration are prudent. (George R. Aronoff, M.D., University of Louisville)