title: Nephrotoxicity of cisplatin combination chemotherapy in thoracic malignancy patients with CKD risk factors.
abstract: BACKGROUND
  Nephrotoxicity is the major side effect that limits the dose of cisplatin that can be safely administered, and it is a clinical problem in cancer patients who received cisplatin combination chemotherapy. Recent evidence has demonstrated that patients with chronic kidney disease (CKD) have an increased risk of developing acute kidney injury (AKI). The present study was conducted to evaluate the prevalence of CKD risk factors in patients who received cisplatin and to assess the correlation between CKD risk factors and cisplatin-induced AKI.
  
  
  METHODS
  We retrospectively analyzed 84 patients treated with cisplatin combination chemotherapy for thoracic malignancies. AKI was defined as a decrease in the estimated glomerular filtration rate (eGFR) > 25% from base line, an increase in the serum creatinine (sCre) level of > 0.3 mg/dl or ≥ 1.5 times the baseline level.
  
  
  RESULTS
  Eighty of the 84 patients (95.2%) had at least one risk factor for CKD. All enrolled patients received cisplatin with hydration, magnesium supplementation and mannitol. Cisplatin-induced AKI was observed in 18 patients (21.4%). Univariate analysis revealed that cardiac disease and use of non-steroidal anti-inflammatory drugs (NSAIDs) were associated with cisplatin-induced nephrotoxicity (odds ratios [OR] 6 and 3.56, 95% confidence intervals [CI] 1.21-29.87 and 1.11-11.39, p = 0.04 and p = 0.04, respectively). Multivariate analysis revealed that cisplatin nephrotoxicity occurred significantly more often in patients with both risk factors (OR 13.64, 95% CI 1.11-326.83, p = 0.04). Patients with more risk factors for CKD tended to have a greater risk of developing cisplatin-induced AKI.
  
  
  CONCLUSIONS
  We should consider avoiding administration of cisplatin to patients with CKD risk factors, particularly cardiac disease and NSAID use.
authors.affiliation: Department of Medicine (II), Niigata University Medical and Dental Hospital, Niigata City, Niigata, Japan.
authors.forename: Ko
authors.initials: K
authors.lastname: Sato
authors.affiliation: Bioscience Medical Research Center, Niigata University Medical and Dental Hospital, Niigata City, Niigata, Japan. satoshi7@med.niigata-u.ac.jp.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Watanabe
authors.affiliation: Department of Medicine (II), Niigata University Medical and Dental Hospital, Niigata City, Niigata, Japan.
authors.forename: Aya
authors.initials: A
authors.lastname: Ohtsubo
authors.affiliation: Department of Medicine (II), Niigata University Medical and Dental Hospital, Niigata City, Niigata, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Shoji
authors.affiliation: Department of Medicine (II), Niigata University Medical and Dental Hospital, Niigata City, Niigata, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Ishikawa
authors.affiliation: Department of Medicine (II), Niigata University Medical and Dental Hospital, Niigata City, Niigata, Japan.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Tanaka
authors.affiliation: Department of Medicine (II), Niigata University Medical and Dental Hospital, Niigata City, Niigata, Japan.
authors.forename: Koichiro
authors.initials: K
authors.lastname: Nozaki
authors.affiliation: Department of Medicine (II), Niigata University Medical and Dental Hospital, Niigata City, Niigata, Japan.
authors.forename: Rie
authors.initials: R
authors.lastname: Kondo
authors.affiliation: Department of Medicine (II), Niigata University Medical and Dental Hospital, Niigata City, Niigata, Japan.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Okajima
authors.affiliation: Department of Medicine (II), Niigata University Medical and Dental Hospital, Niigata City, Niigata, Japan.
authors.forename: Satoru
authors.initials: S
authors.lastname: Miura
authors.affiliation: Department of Health Promotion Medicine, Niigata University Medical and Dental Hospital, Niigata City, Niigata, Japan.
authors.forename: Junta
authors.initials: J
authors.lastname: Tanaka
authors.affiliation: Department of Medicine (II), Niigata University Medical and Dental Hospital, Niigata City, Niigata, Japan.
authors.forename: Takuro
authors.initials: T
authors.lastname: Sakagami
authors.affiliation: Department of Medicine (II), Niigata University Medical and Dental Hospital, Niigata City, Niigata, Japan.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Koya
authors.affiliation: Department of Medicine (II), Niigata University Medical and Dental Hospital, Niigata City, Niigata, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kagamu
authors.affiliation: Bioscience Medical Research Center, Niigata University Medical and Dental Hospital, Niigata City, Niigata, Japan.
authors.forename: Hirohisa
authors.initials: H
authors.lastname: Yoshizawa
authors.affiliation: Department of Medicine (II), Niigata University Medical and Dental Hospital, Niigata City, Niigata, Japan.
authors.forename: Ichiei
authors.initials: I
authors.lastname: Narita
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced / Q000188:drug therapy / Q000473:pathology*; D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood; D004359:Drug Therapy, Combination; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000188:drug therapy / Q000473:pathology*; D012307:Risk Factors; D013899:Thoracic Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000473:pathology
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D003404:Creatinine; D002945:Cisplatin
keywords: Acute kidney injury; Chronic kidney disease; Cisplatin; Nephrotoxicity