medigraphic.com
ISSN 0035-0052 (Print)

2024, Number 6

<< Back Next >>

Rev Mex Pediatr 2024; 91 (6)

Risk factors associated with cisplatin nephrotoxicity in cancer patients

Maceda-Nazario ND, Zurita-Cruz JN, Zepeda-Martínez CC, Alegría-Torres GA, Betanzos-Cabrera Y

Language: Spanish
References: 14
Page: 222-227
PDF size: 350.23 Kb.


ABSTRACT

Introduction: cisplatin-associated nephrotoxicity is primarily related to the accumulation of metabolites in proximal renal tubule cells. Objective: to identify risk factors associated with nephrotoxicity in pediatric cancer patients who received cisplatin. Material and methods: retrospective cohort study. Patients with solid tumors treated between 2015 and 2021 who received cisplatin as part of their oncological treatment were included. All were followed until they completed the cisplatin regimen. Clinical and laboratory data were recorded. Magnesium sulfate use, nephrotoxic administration, cumulative cisplatin dose, and changes in renal function (creatinine and glomerular filtration rate [GFR]) were documented for each chemotherapy cycle. Nephrotoxicity was defined as an increase in serum creatinine > 0.5 mg/dL from baseline. Statistical analysis: comparisons between groups were made using the χ2, Fisher's exact, and Mann-Whitney U tests. Control of confounding variables was with Cox proportional hazards (HR). Results: a total of 101 patients were studied; the median age was 11 years, and 62.4% were men. Median serum creatinine increased from 0.47 mg/dL to 0.72 mg/dL at the end of surveillance, while GFR decreased from 120 to 82 mL/min/1.73 m2. Nephrotoxicity was present in 23.8% of patients, and tubulopathy in 14.8%. Magnesium sulfate administration (HR 0.233; 95% CI 0.926-0.587; p = 0.002) and higher serum phosphorus levels before the start of chemotherapy (HR 0.529; 95% CI 0.315-0.888; p = 0.016) were determined as protectors for this complication. Conclusions: in pediatric cancer patients, the incidence of cisplatin-induced nephrotoxicity is approximately 20%. The administration of magnesium sulfate and higher serum phosphorus concentrations are protective factors for the development of nephrotoxicity.


REFERENCES

  1. LaQuaglia MP, Gerstle JT. Advances in the treatment of pediatric solid tumors: a 50-year perspective. J Surg Oncol. 2022; 126(5): 933-942. doi: 10.1002/jso.27038.

  2. Ward E, DeSantis C, Robbins A, Kohler B, Jemal A. Childhood and adolescent cancer statistics, 2014. CA Cancer J Clin. 2014; 64(2): 83-103. doi: 10.3322/caac.21219.

  3. Papakonstantinou E, Athanasiadou KI, Markozannes G, Tzotzola V, Bouka E, Baka M et al. Prognostic factors in high-grade pediatric osteosarcoma among children and young adults: Greek Nationwide Registry for Childhood Hematological Malignancies and Solid Tumors (NARECHEM-ST) data along with a systematic review and meta-analysis. Cancer Epidemiol. 2024; 90: 102551. doi: 10.1016/j.canep.2024.102551.

  4. Ghosh S. Cisplatin: the first metal based anticancer drug. Bioorg Chem. 2019; 88: 102925. doi: 10.1016/j.bioorg.2019.102925.

  5. Dasari S, Tchounwou PB. Cisplatin in cancer therapy: molecular mechanisms of action. Eur J Pharmacol. 2014; 740: 364-378. doi: 10.1016/j.ejphar.2014.07.025.

  6. Rancoule C, Guy JB, Vallard A, Ben-Mrad M, Rehailia A, Magné N. Les 50 ans du cisplatine [50th anniversary of cisplatin]. Bull Cancer. 2017; 104(2): 167-176. doi: 10.1016/j.bulcan.2016.11.011.

  7. McSweeney KR, Gadanec LK, Qaradakhi T, Ali BA, Zulli A, Apostolopoulos V. Mechanisms of cisplatin-induced acute kidney injury: pathological mechanisms, pharmacological interventions, and genetic mitigations. Cancers (Basel). 2021; 13(7): 1572. doi: 10.3390/cancers13071572.

  8. Malyszko J, Tesarova P, Capasso G, Capasso A. The link between kidney disease and cancer: complications and treatment. Lancet. 2020; 396(10246): 277-287. doi: 10.1016/S0140-6736(20)30540-7.

  9. Caglar K, Kinalp C, Arpaci F, Turan M, Saglam K, Ozturk B et al. Cumulative prior dose of cisplatin as a cause of the nephrotoxicity of high-dose chemotherapy followed by autologous stem-cell transplantation. Nephrol Dial Transplant. 2002; 17(11): 1931-1935. doi: 10.1093/ndt/17.11.1931.

  10. Crona DJ, Faso A, Nishijima TF, McGraw KA, Galsky MD, Milowsky MI. A systematic review of strategies to prevent cisplatin-induced nephrotoxicity. Oncologist. 2017; 22(5): 609-619. doi: 10.1634/theoncologist.2016-0319.

  11. Duffy EA, Fitzgerald W, Boyle K, Rohatgi R. Nephrotoxicity: evidence in patients receiving cisplatin therapy. Clin J Oncol Nurs. 2018; 22(2): 175-183. doi: 10.1188/18.CJON.175-183.

  12. Miyoshi T, Uoi M, Omura F, Tsumagari K, Maesaki S, Yokota C. Risk factors for cisplatin-induced nephrotoxicity: a multicenter retrospective study. Oncology. 2021; 99(2): 105-113. doi: 10.1159/000510384.

  13. Volarevic V, Djokovic B, Jankovic MG, Harrell CR, Fellabaum C, Djonov V et al. Molecular mechanisms of cisplatin-induced nephrotoxicity: a balance on the knife edge between renoprotection and tumor toxicity. J Biomed Sci. 2019; 26(1): 25. doi: 10.1186/s12929-019-0518-9.

  14. Miyoshi T, Hayashi T, Uoi M, Omura F, Tsumagari K, Maesaki S et al. Preventive effect of 20 mEq and 8 mEq magnesium supplementation on cisplatin-induced nephrotoxicity: a propensity score-matched analysis. Support Care Cancer. 2022; 30(4): 3345-3351.




2020     |     www.medigraphic.com