Long-term renal outcomes after cisplatin treatment Journal Article


Authors: Latcha, S.; Jaimes, E. A.; Patil, S.; Glezerman, I. G.; Mehta, S.; Flombaum, C. D.
Article Title: Long-term renal outcomes after cisplatin treatment
Abstract: Background and objectives Nephrotoxicity remains the dose limiting side effect of cisplatin, an effective chemotherapeutic agent with applications across diverse tumor types. This study presents data on renal outcomes across multiple tumor types in 821 adults. We report on incidence of AKI, initial and long-term changes in eGFR after cisplatin, and relationships between cumulative dose, initial eGFR, age, sex, and long term renal function. Design, setting, participants, & measurements This was a retrospective study of adult patients treated with cisplatin from January 1, 2000 to September 21, 2011 who had survived years after initial dose. The Modification of Diet in Renal Disease equation was used to calculate eGFR. AKI was defined as an increase from the baseline creatinine of >25% within 30 days after the first cycle of cisplatin. CM-squared tests were done to evaluate the relationships between categorical or ordinal variables; ANOVAs or t tests were used to evaluate continuous or categorical variables. Changes in eGFR over time were evaluated in a growth curve model. Results Mean follow-up was 6 years (25th and 75th percentiles, 4 and 9 years). AKI occurred in 31.5% of patients, with a median initial decline in eGFR of 10 ml/min per 1.73 m(2) (25th and 75th percentiles, 41.5 and 23.3 ml/min per 1.73 m(2)). At any time point after the first cycle of cisplatin, <3% of patients progressed to eGFR<29 ml/min per 1.73 m(2), and none were known to be on dialysis. Age was associated with a higher risk for AKI after cisplatin. Compared with age <25 years old, the odds ratios for AKI versus no AKI are 1.22 for >26-44 years old (95% confidence interval [95% CI], 0.60 to 2.4), 1.54 for >45-65 years old (95% CI, 0.78 to 3), and 2.96 for >66 years old (95% CI, 1.4 to 6.1). The lowest dose categories of cisplatin (<= 100 and 101-250 mg/m(2)) are associated with increases in eGFR (P=0.06 and P=0.02, respectively) compared with the highest dose category (>701 mg/m(2)). Conclusions This is the largest study of adult patients with cancer who received cisplatin for treatment across multiple tumor types. Most patients experience small but permanent declines in eGFR, but none progressed to ESRD requiring hemodialysis.
Keywords: nephrotoxicity; combination chemotherapy; risk; progression; testicular cancer; toxicity; chronic kidney-disease; cells; drugs; cis-platinum
Journal Title: Clinical Journal of the American Society of Nephrology
Volume: 11
Issue: 7
ISSN: 1555-9041
Publisher: Amer Soc Nephrology  
Date Published: 2016-07-07
Start Page: 1173
End Page: 1179
Language: English
ACCESSION: WOS:000379195500010
DOI: 10.2215/cjn.08070715
PROVIDER: wos
PMCID: PMC4934839
PUBMED: 27073199
Notes: Article -- Source: Wos
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MSK Authors
  1. Sujata Patil
    486 Patil
  2. Sheron Latcha
    25 Latcha
  3. Edgar Alberto Jaimes
    47 Jaimes