Schini M, Peel N, Toronjo-Urquiza L, et al. - Zoledronate, a widely used drug for the treatment of osteoporosis, could contribute to the development of acute kidney injury in a small number of patients. In this study, the current method of determining renal function (eGFR) has been compared with the method proposed by the UK Medicines and Healthcare products Regulatory Agency (CrCl) for predicting AKI after zoledronate infusions.

• From the Metabolic Bone Centre in Sheffield Teaching Hospitals, UK, data of 4,405 patients who received zoledronate (total number of infusions 7,660) was retrieved.

• Both CrCl and eGFR were identified to have significant predictive value for developing AKI within 14 days.

• The current recommended cut-off of CrCl 35 ml/min had poor sensitivity.

• eGFR appeared at least as good as CrCl in predicting AKI.

• eGFR allows the treatment of more patients at high fracture risk.

• Use of eGFR is recommended to assess renal function for zoledronate treatment.

• Patients with eGFR < 50 ml/min/1.73 m² may be provided the infusion over 30 min.