Urinary parameters predictive and electrolyte disturbances of cisplatin-induced acute renal associated with cancer as a critical target of the chemotherapeutic agent in patients with solid tumors

Electrolytes supplementation can decrease the risk of nephrotoxicity in patients with solid tumors undergoing chemotherapy with cisplatin

Background

Cisplatin is an important drug in the treatment of various Cancers. However, this drug causes nephrotoxicity that is linked to electrolyte derangement. The aim of this study was to evaluate the effect of electrolyte supplementation in reducing kidney injury in patients receiving cisplatin-based regimen.

Methods

This was non-randomized interventional study conducted at Ocean Road Cancer Institute (ORCI) among patients with confirmed solid tumors. Patients who received cisplatin-based chemotherapy at a dose of ≥50 mg with intravenous normal saline supplemented with Magnesium, Calcium and Potassium (triple electrolyte supplementation) were compared with those who received cisplatin-based chemotherapy with normal saline alone. The patients were followed up for 4 weeks and serum creatinine was measured at every visit. Nephrotoxicity was defined as serum creatinine elevation > 1.5 times that at baseline.

Results

A total of 99 patients were recruited, whereby 49 patients (49.5%) received electrolyte supplementation (treatment group) and 50 patients (51.5%) did not receive electrolyte supplementation (control group). The incidence risk of nephrotoxicity was 20.41% (n = 10) in the treatment group and 54% (n = 27) in the control group. Patients in the control group were 2.6 times more likely to experience nephrotoxicity as compared to treatment group [Relative Risks (RR); 2.6, 95%CI; 1.5–4.9, P < 0.0001]. The most common malignancy was cervical cancer, n = 43 (87.8%) in treatment group and n = 45 (90.0%) in the control group (P = 0.590). The Kaplan-Meier analysis and the log-rank test revealed that electrolytes supplementation was associated with extended survival with less nephrotoxicity incidences [P = 0.0004; Hazard ratio (HR) 0.3149; 95% CI 0.165 to 0.6011].

Conclusions

Electrolytes supplementation decreases the risk of nephrotoxicity after chemotherapy with cisplatin. A randomized controlled trial with a larger sample size is recommended to evaluate the robustness of these findings.

Cisplatin nephrotoxicity in male beagle dogs: next-generation protein kidney safety biomarker tissue expression and related changes in urine

This 10-day (D) study was conducted to evaluate changes in traditional and newer kidney safety biomarker expression levels in dogs. Animals received cisplatin (CDDP, 0.75 mg per kg per day) or 0.9% Saline (vehicle) for 5 days. Serum/urine samples were collected at various time points. Cage-side observations included emesis (D1-2/D4-D5/D7-9), absence of stool (D5-9/D11), soft stool (D4-7/D12), excessive salivation (D1/D3/D5-6), decreased food consumption (D5-8), decreased activity (D7-8) and/or dehydration (D7). Animals were necropsied when serum creatinine (sCr) levels measured at ≥1.9 mg dL^-1, indicating significant loss of renal function; or at the end of the study (D11). When compared to controls, increases in BUN/sCr were detected on D3, D5 and/or D8. Increases in urinary total protein (Ur TP) were noted on D6. The moribund dog that was euthanized early on D7 showed insignificant increases in urinary osteopontin (Ur OPN), urinary neutrophil gelatinase-associated lipocalin (Ur NGAL), urinary clusterin (Ur CLU), sCr, serum cystatin C (sCYS C) and urinary cystatin C (Ur CYS C) on D5 when compared to controls. Insignificant increases in urinary albumin (Ur ALB) were observed from an animal that was euthanized on D7 and 1 : 2 surviving animals on D8 relative to baseline. From three dogs that were euthanized on D9, increases in Ur CLU, and/or sCYS C were noted on D8 relative to baseline. The two surviving dogs showed elevated Ur CLU and 1 : 2 surviving dogs showed elevated Ur CYS C. Decreased urinary kidney injury molecule 1 (Ur KIM-1) on D3/D5 was evident (versus baseline and controls). CDDP-induced cortico-medullary lesions were characterized as minimal to mild tubule degeneration/necrosis, dilatation, regeneration, cell alteration, intratubular casts, interstitial inflammation and vacuolization. Increased Ur OPN and Ur CLU correlated with enhanced OPN and CLU immunopositive staining in damaged cortical epithelium in the proximal tubules. Enhanced KIM-1 staining in damaged cortico-medullary tubular epithelium appeared in the absence of rises in Ur KIM-1. This study showed changes in kidney safety protein biomarkers associated with CDDP nephrotoxicity in dogs and possibly in humans.