Magnesium supplementation and high volume hydration reduce the renal toxicity caused by cisplatin-based chemotherapy in patients with lung cancer: a toxicity study.

Abstract

BACKGROUND:

Renal toxicity is a clinical problem that affects 28-42% of patients undergoing treatment with cisplatin. Renal toxicity can be minimized by high volume hydration with mannitol diuresis. Recent reports have shown that cisplatin induces depletion of Mg and that Mg supplementation can reduce renal toxicity. We hypothesized that Mg infusion combined with low volume hydration may not be sufficient to overcome cisplatin-induced renal toxicity.

METHODS:

In total, 85 patients with lung cancer receiving their first cycle of cisplatin-based chemotherapy at the Osaka City University Hospital were classified into three groups: those administered high volume hydration without Mg infusion (high-volume Mg-), high volume hydration with Mg infusion (high-volume Mg+), and with low volume hydration with Mg infusion (low-volume Mg+). Serum creatinine (sCr) and creatinine clearance (CrCl) were examined before and after treatment with cisplatin. Multivariable analysis was carried out to identify the most important contributing factors.

RESULTS:

There were no significant differences in pre-treatment sCr levels or CrCl between groups. In the high-volume Mg- group, post-treatment sCr significantly increased compared with pre-treatment levels, while post-CrCl significantly decreased compared with pre-treatment CrCl (p < 0.001 and p < 0.001, respectively). In the high-volume Mg+ group, there was no significant difference between pre- and post-treatment levels of sCr, or between pre- and post-treatment CrCl (p = 0.118 and p = 0.254, respectively). In the low-volume Mg+ group, there was a trend towards increased sCr levels and decreased CrCl after treatment (p = 0.068 and p = 0.055, respectively). Multivariate analysis revealed that the absence of Mg infusion and low-volume hydration were both independent factors for decreased CrCl (p < 0.001 and p = 0.001, respectively).

CONCLUSIONS:

High-volume hydration and Mg infusion reduces the renal toxicity induced by cisplatin. A low-volume Mg+ regimen may be considered for patients with adequate renal function.

TRIAL REGISTRATION:

Observational Study UMIN000013950; Registered 13 May 2014.

• Authors: Takako Oka, Tatsuo Kimura, Tomohiro Suzumura, Naoki Yoshimoto, Toshiyuki Nakai, Norio Yamamoto, Kuniomi Matsuura, Shigeki Mitsuoka, Naruo Yoshimura, Shinzoh Kudoh, Kazuto Hirata
• Journal: BMC pharmacology & toxicology (BMC Pharmacol Toxicol) Vol. 15 Pg. 70 (Dec 04 2014) ISSN: 2050-6511 [Electronic] England
• PMID: 25472655 (Publication Type: Journal Article, Observational Study)

Chemical References

• Antineoplastic Agents
• Hemoglobins
• Rehydration Solutions
• Serum Albumin
• Water
• Creatinine
• Magnesium
• Cisplatin

Topics

• Aged
• Antineoplastic Agents (administration & dosage, adverse effects)
• Antineoplastic Combined Chemotherapy Protocols (adverse effects, therapeutic use)
• Cisplatin (administration & dosage, adverse effects)
• Creatinine (blood, metabolism)
• Female
• Hemoglobins (analysis)
• Humans
• Kidney Diseases (blood, chemically induced, drug therapy, metabolism)
• Lung Neoplasms (blood, drug therapy, metabolism)
• Magnesium (therapeutic use)
• Male
• Middle Aged
• Rehydration Solutions (therapeutic use)
• Serum Albumin (analysis)
• Water (administration & dosage)