Alpha blocker use in females with voiding difficulties and CKD linked to risk of fractures: Study

Alpha blockers (ABs) are frequently prescribed to patients with chronic kidney disease (CKD), which is often complicated by refractory hypertension (HT). Although there have been several reports on the association between Alpha blocker use and the risk of fractures, their conclusions have not yet been drawn. Therefore, this study aimed to investigate the association between Alpha blocker use and the risk of fractures in patients with CKD.

This population-based cohort study used patient data obtained between April 2008 and August 2021 from a large-scale Japanese medical claims database. Consecutive patients with CKD who were newly prescribed vs or non-Alpha blocker antihypertensive drugs were included; males and females were analysed separately. The Alpha blocker group was then divided into Alpha blocker for HT and voiding dysfunction (VD) groups according to the drug approval in Japan.

The primary outcome was the first hospitalisation due to fracture, and the variables were evaluated with weighted Cox proportional hazard model using overlap weights. Results: A total of 65,012, 4,723, and 10,958 males constituted the non-Alpha blocker, Alpha blocker for HT (doxazosin), and Alpha blocker for VD (naftopidil, silodosin, tamsulosin, or urapidil) groups, respectively. A total of 31,887, 2,409, and 965 females constituted the non-AB, AB for HT (doxazosin or guanabenz), and AB for VD (urapidil) groups, respectively. In males, hazard ratio (HR) for primary outcome was not increased in the non-Alpha blocker and Alpha blocker for VD groups compared with the AB for HT group (HR, 0.70; 95% confidence interval [CI], 0.38–1.28 and HR, 1.33; 95% CI, 0.67–2.66, in the non-Alpha blocker and Alpha blocker for VD groups, respectively). Whereas, in females, although HR for the primary outcome was not increased in the non-Alpha blocker group (HR, 1.06; 95% CI, 0.56–1.99), it was significantly increased in the Alpha blocker for VD group (HR, 2.28; 95% CI, 1.01–5.16) compared with the Alpha blocker for HT group.

Alpha blocker use in patients with CKD did not increase the risk of fractures when used for the treatment of HT; however, it increased the risk of fractures when used for the treatment of VD in females. These results suggest that Alpha blockers should be used with caution in these patients.

Reference:

Sunohara, K., Onogi, C., Tanaka, A. et al. Association between alpha blocker use and the risk of fractures in patients with chronic kidney disease: a cohort study. BMC Nephrol 25, 442 (2024). https://doi.org/10.1186/s12882-024-03892-5