PROTECTIVE EFFECT OF MAGNESIUM PRELOADING ON NEPHROTOXICITY CAUSED BY CISPLATIN (OVER 60 MG/M2) IN PATIENTS WITH THORACIC MALIGNANCY

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Abstract

Background

It has been recently reported that magnesium (Mg) preloading might have nephroprotective effect on cisplatin (CDDP)-induced renal dysfunction. Since January2011, we have introduced preloading Mg sulfate just before the administration of CDDP in patients with thoracic malignancy. The aim of this study was to evaluate whether Mg preloading reduced nephrotoxicity caused by CDDP.

Methods

We retrospectively reviewed medical records of 452 patients with thoracic malignancy who were treated with CDDP (over 60 mg/m2)-contained regimen as first-line chemotherapy from January 2009 to September 2011. Renal function was evaluated by serum levels of creatinine (sCr) during first-line chemotherapy. We compared the incidence of grade 2 or more sCr elevation according CTCAE version 4.0 during the first cycle and all cycles between Mg preloading group (n = 115 (25%), January 2011–September 2011) and non-Mg preloading group (n = 337 (75%), January 2009–December 2010).

Results

The median age and average number of the administered cycles were 64 (range: 35–76) years, 3.20 in preloading group and 65 (range: 28–79) years, 3.22 in non-preloading group, respectively. Median creatinine clearance (Ccr) estimated by Cockcroft–Gault formula before chemotherapy was 79.9 ml/min in preloading group and 83.6 ml/min in non-preloading group. Hydration method except Mg preloading was the same in the two groups. Eighty-one of 115 (71%) patients were treated with CDDP 80 mg/m2 contained regimen in Mg preloading group and 241 (70%) of 337 patients in non-Mg preloading group at the first cycle. The incidence of grade 2 or more sCr elevation was 5%, 17% in preloading group, compared with 19%, 40% in non-preloading groups (P < 0.05) during the first cycle and all cycles. Multivariate analysis with other risk factors, co-administered non-steroidal anti-inflammatory agents, indicated that on-Mg preloading was a significant risk factor of nephrotoxicity caused by CDDP during first-line chemotherapy (odds ratio (OR): 3.79, 95% confidence interval (CI): 1.71–10.09 during the first cycle, and OR: 3.67, 95% CI: 2.13–6.64 during all cycles, respectively).

Conclusions

Mg preloading significantly reduced nephrotoxicity caused by CDDP (over 60 mg/m2).

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