Determining factors of renal dysfunction during cisplatin chemotherapy

Abstract

Cisplatin remains one of the most active antineoplastic treatments used in oncology, being the most prestigious exponent of the golden age in chemotherapy at the end of the 20th century. This chemotherapeutic drug is used for curative or palliative treatments in testicular, ovarian, head and neck neoplasms, sarcomas and lymphomas. The limiting dose adverse effect of cisplatin is nephrotoxicity. The present study aimed to evaluate the magnitude of the damage to renal function and to identify the risk or protective factors in renal toxicity. The retrospective study was performed using 81 consecutive patients who underwent at least three cycles of cisplatin chemotherapy. The results indicate an average decline in glomerular filtration rate (GFR) of 9 ml/min. Women appear to be less by a decline in renal function (a relative decline of GFR of -5% for women compared to -9% for men). The decline in GFR was found to be proportional to age; overweight (not obese) individuals had the best renal function behavior under cisplatin treatment, while the association of anaemia appears to be a risk factor for renal toxicity. The use of cisplatin in oncology in the last years may have decreased, either by using combination chemotherapy instead of monotherapy, or by its displacement by newly discovered treatments (e.g., immunotherapy in lung cancer). Therefore, it is possible that the profile of patients who are exposed to this drug and the duration of exposure have been modified compared to previous studies. The objectives of the present study were to assess the magnitude of the renal function damage during cisplatin treatment and to identify the risk and the protective factors in term of renal toxicity.

Keywords: anaemia; chemotherapy; cisplatin; glomerular filtration rate; renal toxicity.

Figure 1

Evolution of the glomerular filtration rate (ml/min) by treatment cycles and sex. GFR, glomerular filtration rate.

Figure 2

Evolution of GFR (ml/min) by treatment cycle and age group. GFR, glomerular filtration rate.

Figure 3

Evolution of GFR (ml/min) in the first three cycles of administration according to BMI (kg/m²). GFR, glomerular filtration rate; BMI, BMI, body mass index.

Figure 4

Evolution of GFR (ml/min) in the first three cycles of administration depending on the presence of anemia. GFR, glomerular filtration rate.