Is it common to check renal function after Reclast (zoledronic acid) infusion for Impaired renal function?

From the Guidelines

Yes, it is common to check renal function after Reclast (zoledronic acid) infusion, as recommended by the American Society of Clinical Oncology in 2007 1.

Monitoring Renal Function

Patients typically have their kidney function monitored before the infusion, and then follow-up testing is recommended at 10 days post-infusion, particularly for those with pre-existing kidney disease or risk factors for renal impairment.

• Reclast is primarily eliminated by the kidneys, and there is a risk of acute kidney injury, especially in patients with underlying renal dysfunction, dehydration, or those taking nephrotoxic medications.
• The monitoring usually includes serum creatinine and estimated glomerular filtration rate (eGFR).
• For patients with normal baseline renal function and no risk factors, some clinicians may not perform the 10-day check, but annual renal function testing before each subsequent dose is still standard practice.
• Adequate hydration before and after the infusion is also recommended to reduce the risk of renal adverse effects.

Importance of Monitoring

This monitoring is important because early detection of kidney function changes allows for appropriate management and potential adjustment of future dosing, as the Update Committee recommends that serum creatinine should be monitored before each dose of pamidronate or zoledronic acid, in accordance with US Food and Drug Administration–approved labeling 1.

• In patients who develop renal deterioration with no other apparent cause during bisphosphonate therapy, zoledronic acid or pamidronate should be withheld.
• Bisphosphonate therapy can be resumed, at the same dosage as that before treatment interruption, when the serum creatinine returns to within 10% of the baseline level.
• The Update Committee also recommends intermittent evaluation (every 3 to 6 months) of all patients receiving pamidronate or zoledronic acid therapy for the presence of albuminuria.

From the FDA Drug Label

Due to the risk of clinically significant deterioration in renal function, which may progress to renal failure, single doses of zoledronic acid injection should not exceed 4 mg and the duration of infusion should be no less than 15 minutes [see Warnings and Precautions (5. 3)]. Standard hypercalcemia-related metabolic parameters, such as serum levels of calcium, phosphate, and magnesium, as well as serum creatinine, should be carefully monitored following initiation of therapy with zoledronic acid injection Zoledronic acid injection is excreted intact primarily via the kidney, and the risk of adverse reactions, in particular renal adverse reactions, may be greater in patients with impaired renal function.

Yes, it is common to check renal function after Reclast infusion, as the drug label warns about the risk of renal deterioration and recommends monitoring serum creatinine levels after initiation of therapy with zoledronic acid injection 2.

• Key points to consider:
  • Monitoring of renal function is crucial due to the risk of renal deterioration
  • Serum creatinine levels should be carefully monitored after initiation of therapy
  • The risk of renal adverse reactions may be greater in patients with impaired renal function

From the Research

Renal Function After Reclast Infusion

• It is common to check renal function after Reclast (zoledronic acid) infusion, as the medication can cause acute kidney injury (AKI) in some patients 3, 4, 5.
• The risk of nephrotoxicity is low, but patients with pre-existing renal impairment are at higher risk 3, 5.
• Studies have shown that estimated glomerular filtration rate (eGFR) is a useful predictor of AKI after zoledronic acid infusion, and may be more practical to use than creatinine clearance (CrCl) 3.
• The UK Medicines and Healthcare products Regulatory Agency (MHRA) recommends using CrCl to assess renal function before zoledronic acid infusion, but some studies suggest that eGFR may be a better predictor of AKI 3.
• Patients with baseline renal dysfunction may still be able to receive zoledronic acid infusion, but should be closely monitored for signs of AKI 4, 5.

Assessment of Renal Function

• Serum creatinine is the most widely used functional biomarker of kidney function, but it has its limitations 6.
• eGFR is a useful estimate of renal function, and can be used to predict the risk of AKI after zoledronic acid infusion 3, 5.
• The Cockcroft-Gault equation and CKD-EPI equation are two different methods for estimating renal function, and may give different results 5.

Clinical Implications

• Patients receiving zoledronic acid infusion should be monitored for signs of AKI, including changes in serum creatinine and eGFR 3, 4, 5.
• Patients with pre-existing renal impairment should be closely monitored, and may require dose adjustments or alternative treatments 3, 4, 5.
• Further studies are needed to evaluate the use of zoledronic acid in patients with severe renal impairment (CrCl < 35 mL/min) 5.