Prevention of Cisplatin-Induced Nephrotoxicity
Adequate hydration before, during, and after cisplatin administration is essential for preventing cisplatin-induced nephrotoxicity, with intravenous fluids required before and after each cycle of cisplatin. 1
Hydration Protocol
Pre-Hydration
- Administer 1-2 L of isotonic saline prior to cisplatin administration 1
- Begin hydration several hours before cisplatin infusion
During and Post-Hydration
- Continue IV fluids for several hours after cisplatin infusion 1
- Some patients may require continued IV fluids for 5-7 days in outpatient setting to prevent or treat dehydration 1
Alternative Hydration Approaches
- Short-duration, low-volume hydration regimens have been shown to be effective and safe, even with intermediate to high-dose cisplatin 2
- Oral hydration after cisplatin may be considered as a safe alternative to IV hydration in appropriate patients, particularly in outpatient settings 3
Electrolyte Management
- Add 8-16 milliequivalents of magnesium to hydration regimen to prevent hypomagnesemia and provide nephroprotection 1, 2
- Monitor electrolytes closely, particularly magnesium, calcium, and potassium levels 1
- Cisplatin administration is associated with hypomagnesemia which may persist long-term 4
Diuresis Management
- Consider adding mannitol to the hydration regimen for forced diuresis, particularly for high-dose cisplatin and/or patients with preexisting hypertension 5, 2
- Mannitol has shown nephroprotective effects in multiple studies 2
Dose Considerations
- Consider lower cisplatin dose (75 mg/m² vs 100 mg/m²) to decrease toxicity 1
- For intraperitoneal administration, dose reduction to 75 mg/m² may reduce toxicity 1
Monitoring Protocol
Before Each Cycle
- Monitor renal function before each cycle 1, 6
- Check BUN, creatinine, serum uric acid, and creatinine clearance 1, 6
- Renal function must return to normal before another dose of cisplatin can be given 6
During Treatment
- Watch for early signs of nephrotoxicity 1
- Monitor for myelosuppression, dehydration, and electrolyte loss 1
- Monitor peripheral blood counts weekly 6
Special Considerations
Elderly Patients
- Require closer monitoring due to higher susceptibility to nephrotoxicity 1, 6
- More likely to have decreased renal function at baseline 6
- May be more susceptible to myelosuppression and infectious complications 6
Long-Term Effects
- Long-term nephrotoxicity is frequently asymptomatic but may be associated with up to a 30% reduction in glomerular filtration rate 4
- Even small reductions in GFR have an adverse impact on cardiovascular disease and all-cause mortality 4
- Renal function typically decreases in a dose-dependent pattern after cisplatin therapy and then either remains stable or improves during the next 5–10 years 4
Implementation Notes
- The 6-8 hour infusion with intravenous hydration and mannitol has been used to reduce nephrotoxicity, though renal toxicity can still occur 6
- Nephrotoxicity has been noted in 28-36% of patients treated with a single dose of 50 mg/m² 6
- Renal toxicity typically manifests during the second week after a dose 6