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Among those using nephrotoxic agents after their bone metastasis diagnosis, IV BP use was observed in 6402 patients (79%). Zoledronic acid was the [http://www.selleckchem.com/products/JNJ-26481585.html http://www.selleckchem.com/products/JNJ-26481585.html] most commonly used nephrotoxic agent (77%), followed by carboplatin (31%), bevacizumab (16%), and gemcitabine (16%) (Table S1). RI was common among patients with bone metastases, with 43% of patients having at least one eGFR [http://en.wikipedia.org/wiki/Ankyrin ankyrin] points) among patients in the lowest two categories (Fig.?(Fig.22). Table 2 Prevalence of renal impairment and use of nephrotoxic agents Figure 2 Intravenous bisphosphonates use in patients with renal impairment (N?=?5097). A similar trend was observed in the use of any nephrotoxic therapy, including IV BPs, with the percentage of patients using these agents decreasing from 64% to 50% after RI was detected (Table?(Table2).2). As with IV BP use alone, larger decreases in use of nephrotoxic agents were observed among patients with the greatest levels of RI. Approximately 70% (8247) of patients in the study population had at least two eGFRs 90?days or more apart (Table?(Table3).3). CKD prevalence was 35% overall (76% among patients with renal tumors; 31% to 38% among patients with other tumor types, Table?Table4)4) and 71% among the 4258 patients with RI and two eGFRs at least 90?days apart. Before the confirming eGFR, 56% of CKD patients received IV BP, compared with 46% in the 12?months afterwards (Table?(Table3).3). Similarly, 72% of CKD patients received at least one nephrotoxic agent (including IV BP) prior to confirmation, compared with 59% of patients afterwards. Among the 1687 patients who received any nephrotoxic agent after CKD was confirmed, 13% received both an IV BP and another nephrotoxic agent. Table 3 Prevalence of CKD and use [http://www.selleckchem.com/GSK-3.html GSK3 inhibitor] of nephrotoxic agents Table 4 Prevalence of CKD and use of nephrotoxic agents by tumor type Discussion This study is the first to examine the prevalence of RI and use of nephrotoxic agents in patients with bone metastases secondary to solid tumors. Based on the presence of a single eGFR