DA LI ZAISTA ZNAMO FUNKCIJU BUBREGA PRE INJEKCIJE ZOLEDRONATA

I recently attended a presentation by a bone specialist on the proposed use of intravenous zoledronate after hip fracture. I fully understand and strongly support the clinical objective of improving access to effective secondary fracture prevention in this highly vulnerable population. Intravenous zoledronate is an effective and pragmatic treatment option, and the under-treatment of patients after hip fracture remains a major clinical problem. However, I was struck by the central role given to Cockcroft–Gault creatinine clearance in the proposed renal decision pathway.

Cockcroft–Gault equation is outdated, and its historical use in drug labelling should not be conflated with physiological superiority or individual accuracy. The equation estimates creatinine clearance rather than true glomerular filtration rate (GFR); it was developed before modern IDMS-traceable creatinine assays and performs poorly against measured GFR. This has been demonstrated in a large analysis of creatinine-based equations specifically adapted to the context of drug dosage adjustment. GFR was ex pressed in non-indexed mL/min and validated against measured GFR in 14,804 participants. Of all equations tested – including MDRD, CKD-EPI, LMR and EKFC – Cockcroft–Gault performed worst across key metrics: bias, imprecision, P30 accuracy and correct classification into GFR categories. The authors concluded that Cockcroft–Gault should not be used for drug dosage decisions…