Effect of hydration with electrolytes supplementation on cisplatin induced nephrotoxicity among patients with solid tumors at Ocean Road Cancer Institute

Abstract

ABSTRACT BACKGROUND: Nephrotoxicity remains a problem for patients who receive cisplatin based chemotherapy. Electrolyte derangements are known as a complication to chemotherapy with cisplatin and likely to enhance nephrotoxicity. AIM: To evaluate the effects of pre-hydration with a solution containing magnesium sulfate, potassium chloride and calcium gluconate on cisplatin induced nephrotoxicity in cancer patients receiving cisplatin chemotherapy at Ocean Road Cancer Institute. METHODOLOGY: 99 patients diagnosed with cancer and who were to receive cisplatin based chemotherapy at ORCI at a dose of ≥50mg were randomly assigned to receive either intravenous electrolyte supplementation plus cisplatin as intervention arm or cisplatin in normal saline alone as control arm. Serum creatinine (SCr) was measured at every visit. The follow-up period was 6weeks. The primary outcome measure was incidence of acute kidney injury grade I or higher as defined by the Common Terminology Criteria for Adverse Events version 4.0. RESULTS: A total of 99 patients were recruited, where 49 patients (49.5%) were randomized to receive NaCl + electrolytes (treatment group) while 50 patients (51.5%) received NaCl alone (control group). The incidence risk of a grade I or higher Cisplatin Induced Nephrotoxicity (CIN) was 20.41% (n=10) in the treatment group and 54% (n=27) in the control group. Patients received NaCl alone were 2.6 times more likely to get CIN than those who received NaCL + Electrolyte [Realative Risks (RR); 2.6, 95%CI; 1.5-4.9, P  0.0001]. The most common malignancy was cervical cancer, n = 43 (87.8%) in treatment group and n= 45 (90.0%) in the control group (P = 0.590). The Kaplan-Meier analysis and the log-rank test revealed that electrolytes supplementation was associated with extended survival without cisplatin-induced nephrotoxicity [P = 0.0004; Hazard ratio (HR) 0.3149; 95% CI 0.165 to 0.6011]. CONCLUSION: Hydration with magnesium sulfate, potassium chloride and calcium gluconate decreases the risk of cisplatin nephrotoxicity. A randomized controlled trial with larger sample size is recommended to evaluate the robustiness of this protocol