title: Hydration with magnesium and mannitol without furosemide prevents the nephrotoxicity induced by cisplatin and pemetrexed in patients with advanced non-small cell lung cancer.
abstract: BACKGROUND
  The aim of this study was to examine the effect of hydration with magnesium and mannitol without furosemide on the nephrotoxocity accompanying combination chemotherapy using cisplatin and pemetrexed in patients with advanced non-small cell lung cancer (NSCLC).
  
  
  METHODS
  Fifty patients with NSCLC who received cisplatin plus pemetrexed, using either old hydration protocol including normal saline with mannitol and furosemide, or a new one including normal saline with magnesium and mannitol without furosemide were retrospectively analyzed. Nephrotoxicity was compared between patients treated using the old protocol and those treated with the new protocol. Univariate and multivariate analyses were performed to identify the independent factors associated with protection against nephrotoxicity in patients with NSCLC who received cisplatin plus pemetrexed.
  
  
  RESULTS
  Thirty patients received the old hydration protocol, while 20 patients were treated using the new hydration protocol. The patients treated using the new hydration protocol showed a significantly greater increase in creatinine clearance (P=0.0004) and a decrease in the serum creatinine level (P=0.0148) after one course of chemotherapy compared with those treated using the old hydration protocol. There were no differences in the chemotherapeutic response or overall survival between the groups (P=0.572). The new hydration protocol with supplemented magnesium with mannitol without furosemide was an independent factor for the protection against nephrotoxicity induced by cisplatin and pemetrexed in patients with advanced NSCLC [HR 0.232 (95% CI: 0.055-0.986), P=0.039].
  
  
  CONCLUSIONS
  These results demonstrate that the new hydration protocol comprising supplementation with magnesium without furosemide could prevent the nephrotoxicity induced by cisplatin and pemetrexed without affecting the treatment outcome.
authors.affiliation: Department of Respiratory Medicine, Juntendo University, School of Medicine, Japan.
authors.forename: Keiko
authors.initials: K
authors.lastname: Muraki
authors.forename: Ryo
authors.initials: R
authors.lastname: Koyama
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Honma
authors.forename: Shigehiro
authors.initials: S
authors.lastname: Yagishita
authors.forename: Takehito
authors.initials: T
authors.lastname: Shukuya
authors.forename: Rina
authors.initials: R
authors.lastname: Ohashi
authors.forename: Fumiyuki
authors.initials: F
authors.lastname: Takahashi
authors.forename: Kenji
authors.initials: K
authors.lastname: Kido
authors.forename: Shin-Ichiro
authors.initials: S
authors.lastname: Iwakami
authors.forename: Shinichi
authors.initials: S
authors.lastname: Sasaki
authors.forename: Akihiko
authors.initials: A
authors.lastname: Iwase
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Takahashi