A Systematic Review of Strategies to Prevent Cisplatin-Induced Nephrotoxicity
Crona DJ, Faso A, Nishijima TF, McGraw KA, Galsky MD, Milowsky MI
The oncologist · 303 citations
How it was studied
- Design
- Systematic review (indexed by PubMed)
- Studied in
- People
- Main outcome
- Health markers and function
Who paid for it
- Funding
- Independent funding
- Government
- National Institute of General Medical Sciences
- Government
- NIGMS NIH HHS
- Grants
- National Institute of General Medical Sciences (T32-GM086330)
Based on 2 listed funder(s).
Publication
- Published
- 2017-04-24 · Oncologist · vol. 22 · issue 5 · pp. 609–619
- Publisher
- AlphaMed Press
- Cited
- 404 citations · more than 98% of similar papers · 5.7× the field average
- Impact
- Top 10% most cited in its field
- References
- 54 works
- Access
- Free to read
- Research areas
- Chemotherapy-induced organ toxicity mitigation · Chemotherapy-induced cardiotoxicity and mitigation · Cancer Treatment and Pharmacology
- Keywords
- Medicine, Nephrotoxicity, Cisplatin, Diuresis, Pharmacology, Intensive care medicine, Urology, Toxicity, Internal medicine, Chemotherapy, Renal function
- MeSH
- kidney, humans, neoplasms, cisplatin, antineoplastic agents, evidence-based medicine, dose-response relationship, drug, female, male, drug-related side effects and adverse reactions
6 authors
From US
- Daniel James CronaUniversity of North Carolina at Chapel Hill; University of North Carolina Hospitals; UNC Lineberger Comprehensive Cancer Center
- Aimee FasoUniversity of North Carolina Hospitals
- Tomohiro F. NishijimaUniversity of North Carolina at Chapel Hill
- Kathleen A. McGrawUniversity of North Carolina at Chapel Hill
- Matthew D. GalskyIcahn School of Medicine at Mount Sinai
- Matthew I. Milowsky · correspondingUniversity of North Carolina at Chapel Hill; UNC Lineberger Comprehensive Cancer Center
Abstract
Introduction
Cisplatin, a platinum-based antineoplastic agent, is the cornerstone for the treatment of many malignancies. Nephrotoxicity is the primary dose-limiting toxicity, and various hydration regimens and supplementation strategies are used to prevent cisplatin-induced kidney injury. However, evidence-based recommendations on specific hydration regimens are limited. A systematic review was performed to evaluate clinical studies that have examined hydration and supplementation strategies to prevent cisplatin-induced nephrotoxicity.
Materials and methods
PubMed and Excerpta Medica databases were searched from 1966 through October 2015 for clinical trials and other studies focused on hydration regimens to prevent nephrotoxicity in cancer patients treated with cisplatin. The University of Oxford Centre for Evidence-Based Medicine criteria were used to grade level of evidence.
Results
Among the 1,407 identified studies, 24 were included in this systematic review. All studies differed on type, volume, and duration of hydration. Among the 24 studies, 5 evaluated short-duration hydration, 4 evaluated low-volume hydration, 4 investigated magnesium supplementation, and 7 reviewed forced diuresis with hydration. Short-duration and lower-volume hydration regimens are effective in preventing cisplatin-induced nephrotoxicity. Magnesium supplementation may have a role as a nephroprotectant, and forced diuresis may be appropriate in some patients receiving cisplatin.
Conclusion
Hydration is essential for all patients to prevent cisplatin-induced nephrotoxicity. Specifically, short-duration, low-volume, outpatient hydration with magnesium supplementation and mannitol forced diuresis (in select patients) represent best practice principles for the safe use of cisplatin. The Oncologist 2017;22:609-619 IMPLICATIONS FOR PRACTICE: The findings contained within this systematic review show that (a) hydration is essential for all patients to prevent cisplatin-induced nephrotoxicity, (b) short-duration, low-volume, outpatient hydration regimens appear to be safe and feasible, even in patients receiving intermediate- to high-dose cisplatin, (c) magnesium supplementation (8-16 milliequivalents) may limit cisplatin-induced nephrotoxicity, and (d) mannitol may be considered for high-dose cisplatin and/or patients with preexisting hypertension. These findings have broad implications for clinical practice and represent best practice principles for the prevention of cisplatin-induced nephrotoxicity.
Abstract via Europe PMC. Copyright remains with the authors or publisher.
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