Abstract:
Background: The use of cisplatin is limited by the development of nephrotoxicity, with an incidence approaching 30%. It is unclear if a risk prediction score can effectively predict the development of nephrotoxicity throughout all cycles of cisplatin therapy among outpatients.
Methods: Retrospective, observational study evaluating adult patients receiving cisplatin in outpatient infusion centers from January 2009 – November 2019 (n=186). A risk prediction score consisting of patient age, cisplatin dose, hypertension, and serum albumin was calculated to predict the risk of cisplatin-induced nephrotoxicity.
Results: The incidence of nephrotoxicity was 23.7% overall, with 8.1% of patients developing cisplatin-induced nephrotoxicity after the first dose. Patients who developed nephrotoxicity had a higher mean risk prediction score compared to patients who did not have nephrotoxicity (4.0 ± 2.0 vs 2.9 ± 2.1, p = 0.004, respectively). Multivariate logistic regression demonstrated each 1-point increase in the risk prediction score increased the odds of nephrotoxicity by 26.5% (OR: 1.27; 95% CI: 1.02-1.57, p=0.034). Presence of diabetes mellitus increased the odds of cisplatin-induced nephrotoxicity (OR 3.66; 95% CI: 1.43-9.33, p=0.007); whereas receipt of greater than or equal to 1 liter of 0.9% sodium chloride was protective, decreasing the odds of developing nephrotoxicity by 25%.
Conclusion: By identifying patients at the highest risk of cisplatin-induced nephrotoxicity, providers can individualize risk reduction strategies. The use of a risk prediction model successfully predicted the risk of nephrotoxicity throughout all cycles of cisplatin in an outpatient setting.
Reference:
Burns CV, Edwin SB, Szpunar S, Forman J. Cisplatin-Induced Nephrotoxicity in an Outpatient Setting. Pharmacotherapy. 2021 Jan 8. doi: 10.1002/phar.2500. Epub ahead of print. PMID: 33417725.