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2016 ; 11
(7
): 1173-1179
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Long-Term Renal Outcomes after Cisplatin Treatment
#MMPMID27073199
Latcha S
; Jaimes EA
; Patil S
; Glezerman IG
; Mehta S
; Flombaum CD
Clin J Am Soc Nephrol
2016[Jul]; 11
(7
): 1173-1179
PMID27073199
show ga
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 ?5 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.
Chi-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.
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