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73?m2. IV BP use appeared to decrease after RI was observed. Nearly half (48%) of patients with RI used IV BP in the 12?months prior to their lowest eGFR compared with 37% in the 12?months following their lowest eGFR. This utilization pattern was observed in all three eGFR categories (PDK4 absolute drop of 30�C32 percentage 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 Epigenetics inhibitor 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 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 Pifithrin-�� in vivo method, the 5-year prevalence (2009�C2013) of RI was 43% among these patients with bone metastases secondary to solid tumors. The prevalence of CKD was 35% among patients with at least two eGFRs available. IV BP was the most commonly used nephrotoxic agent before and after RI and CKD were detected. In 2007, Launay-Vacher et?al. published results from the Renal Insufficiency and Anticancer Medications (IRMA) study which was a large observational cohort study conducted to assess the prevalence of renal insufficiency in cancer patients in France 20. Although the patient population (all cancer patients) and elements of the study design (e.g.