Cisplatin-induced Nephrotoxicty and its Predisposing Factors for Unrecovered Kidney Injury: A Report from Indonesia National Cancer Center

Abstract

BACKGROUND: Cisplatin-induced nephrotoxicity is the most common and devastating side effects which affects long-term outcome. It may be reversible in some patients but may also cause permanent kidney injury. AIM: This research aims to evaluate risk factors of cisplatin nephrotoxicity and unrecovered kidney function at national cancer hospital in Indonesia. METHODS: This is a retrospective and cohort study conducted at Dharmais National Cancer Hospital, Jakarta, Indonesia. All cancer patients aged 18 years old and above, who received cisplatin-based regimen as the first-line chemotherapy and completing all cycles with at least four cycles, were included in the study. Demographic data were collected and kidney function was evaluated using estimated glomerular filtration rate (eGFR) before, 3 times during chemotherapy, 1 and 3 months after the last dose. RESULTS: A total of 177 patients were included in the analysis, with mean age of 45.80 ± 11.75 years old, majority diagnosed with nasopharynx cancer (58.8%), and have baseline eGFR of 102.76 ± 20.68 mL/min 1.73m2. Nephrotoxicity is occurred in 80 (45.2%) patients with 27 (15.3%) toxicity occurred after the first cycle. Age above 50, hypertension and non-steroidal anti-inflammatory drugs (NSAID) use associated with increased risk of cisplatin-induced nephrotoxicity. Nephrotoxicity risk factors include age above 50 (OR 4.18, 95% CI 2.11–8.28; p < 0.0001), hypertension (OR 2.03, 95% CI 1.03–4.01; p = 0.040), and NSAID use (OR 2.34, 95% CI 1.22–4.93; p = 0.025). Risk factors of patients who unrecovered above 75% eGFR baseline were hypertension (OR 0.47, 95% CI 0.17–0.56; p = 0.001) and gender (OR 0.018, 95% CI 0.03–0.95; p = 0.043). CONCLUSION: Nephrotoxicity occurs in 45.2% patients throughout cisplatin-based chemotherapy cycles. Risk factors of nephrotoxicity includes age above 50, hypertension, and NSAID while hypertension and female gender are risk factor for not recover above 75% eGFR baseline after cisplatin cycles.