Risk analysis for cisplatin-induced nephrotoxicity during first cycle of chemotherapy

Although cisplatin is one of the most widely used anticancer drugs, nephrotoxicity remains a major doselimiting side effect. To reduce the incidence of cisplatin-induced nephrotoxicity, we analyzed possible risk factors in 349 patients who received cisplatin (15-120 mg/m2) for the first cycle of chemotherapy between April 2011 and March 2014. Nephrotoxicity was defined as serum creatinine elevation > 1.5 times that at baseline (grade ≥ 2) from 4 to 7 days after injection, according to the Common Terminology Criteria for Adverse Events Version 4.0. Dose of cisplatin > 20 mg/m2 significantly increased serum creatinine concentration and caused nephrotoxicity in a dosedependent manner, with a 13.7% incidence of nephrotoxicity (30/219) at doses > 40 mg/m2. A multivariate logistic regression analysis revealed the following as significant risk factors for cisplatin-induced nephrotoxicity: age ≥ 65 years, low serum albumin (≤ 3.5 g/dl), high doses (≥ 80 mg/m2) of cisplatin and the use of mannitol. Risk factors of cisplatin nephrotoxicity were old age, low serum albumin, high dose of cisplatin, and inclusion of mannitol in transfusion. Mannitol should therefore not be included in intravenous hydration. In addition, as the number of risk factors increased, so did the incidence of cisplatin-induced nephrotoxicity.