PREDICTION OF NEPHROTOXICITY INDUCED BY CISPLATIN CHEMOTHERAPY IN CANCER PATIENTS.

Background:- Cisplatin nephrotoxicity can present in a number of ways, the most serious is acute kidney injury which occurs in 20–30% of patients. Other presentations include hypomagnesemia, distal renal tubular acidosis, hypocalcemia, renal salt wasting, renal concentrating defect, hyperuricemia, transient proteinuria, erythropoietin deficiency, thrombotic microangiopathy and chronic renal failure. Objective:- To determine the incidence and risk factors for nephrotoxicity induced by cisplatin. Methods:- Patients’ files were retrospectively reviewed for demographic and clinical variables. Creatinine clearance was calculated using Cockcroft-Gault formula. Nephrotoxicity was defined as increase in creatinine level more than 1.5 times of baseline or decrease in creatinine clearance level more than 25% of baseline. Results:- A total of 415 patients were recruited, with range of age 16-86 years. 211 patients were males while 204 patients were females. There were 32 hypertensive patients, 49 diabetic patients and 108 smoker patients. 58.3 % of patients had metastaic disease. The most frequent tumors were gastro intestinal, lung and breast cancers. 85 of the 415 patients (20.5%) developed nephrotoxicity. Risk factors include age more than 60 years, diabetes mellitus, hypertension, cumulative dose > 450mg/m2, anemia, combination chemotherapy regimens, and number of cycles more than 8 cycles, while gender, body mass index and smoking were not considered a significant risk factors for nephrotoxicity. Conclusion:- Patients with risk factors for nephrotoxicity should be closely monitored, adequately hydrated, supplemented sufficiently with magnesium with avoidance of other nephrotoxic agents.