Chemotherapy-Related Kidney Injury More Likely in Certain Patients

Researchers potentially found a way to determine which patients are likely to experience chemotherapy-related kidney injury from cisplatin. Some patients may have 20 times higher risk than others, according to research published in The BMJ.

“Patients receiving treatment for cancer are increasingly affected by kidney injury, which is associated with higher mortality and can jeopardize eligibility for other therapies,” study author, Dr. Shruti Gupta, director of Onco-nephrology at BWH and Dana-Farber and a physician in BWH’s Division of Renal Medicine, said in a press release about the findings.

Factors Associated With Kidney Injury

The researchers examined data from 12,951 patients with cancer who received treatment with cisplatin. Among these patients, 421 (3.3%) developed cisplatin-related acute kidney injury. This was defined as doubling or more in serum creatinine or kidney replacement therapy within two weeks of receiving cisplatin.

The following characteristics were associated with an increased risk of kidney injury:

• Older age
• High blood pressure
• Diabetes mellitus
• Serum creatinine level
• Hemoglobin level
• White blood cell count
• Platelet count
• Serum albumin level
• Serum magnesium level
• Cisplatin dose

Additionally, findings showed that patients who experienced acute kidney injury had a higher death risk than those without kidney issues.

Predicting and Preventing Chemotherapy-Related Kidney Injury

According to the researchers, there is a need for more measures to prevent or mitigate kidney injury, given cisplatin's common usage in cancer therapy.

“Cisplatin is a well-known kidney toxin, and even though there are newer treatments available, it remains a cornerstone of therapy for patients with cancer globally. This large, multicenter collaboration and resulting risk prediction model is an important step in the care of patients who are getting cisplatin,” Gupta said.

Kidney injury is not the only common side effect of cisplatin. Prior research also showed that the drug can cause long-term hearing loss.

READ MORE: Chemo-Related Hearing Loss Is Common in Survivors of Testicular Cancer, Other Cancer Types

The study authors now plan to use the database to guide therapies to prevent kidney injury. One proposed idea is the use of magnesium.

“Though some of these risk factors may simply reflect overall health, serum magnesium is particularly intriguing. [Decreased magnesium levels] due to renal magnesium wasting is a well-recognized manifestation of [cisplatin-related acute kidney injury], but [decreased magnesium levels] as a risk factor for [cisplatin-related acute kidney injury] has not been well documented,” the study authors wrote. “Future studies should examine whether overall kidney health, assessed not only by serum creatinine but also by proteinuria and electrolyte abnormalities indicative of tubular dysfunction, aid in risk prediction of [cisplatin-related acute kidney injury].”

The researchers also created an online calculator that patients and doctors can use to determine cisplatin-related kidney injury risk.

“This new tool can help an oncologist and a patient have more informed conversations about the risks and benefits of cisplatin. If a patient is at high risk, their clinical team can consider preventative measures such as administering more IV fluids before receiving cisplatin or monitoring their kidney function more closely afterward,” said senior author Dr. David E. Leaf, director of clinical and translational research in acute kidney injury at BWH’s Division of Renal Medicine. “The clinical characteristics and lab values that are incorporated in our model are readily available and easily obtainable from medical records, so our hope is that this tool can be implemented anywhere cisplatin is given.”

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