Platinum-based chemotherapy and nephrotoxicity: frequency, clinical characteristics and outcomes in a mexican tertiary-centre cohort

Abstract

Abstract

Platinum-based agents (cisplatin, carboplatin, and oxaliplatin) are essential in the treatment of solid tumors, but they are associated with nephrotoxicity. Acute kidney injury (AKI) occurs most frequently with cisplatin and can lead to treatment delays, dose reduction, or discontinuation, as well as increasing the risk of renal adverse events and mortality. In Latin America, evidence on incidence, associated factors, and outcomes is limited. To estimate the frequency of platinum-based chemotherapy-induced nephrotoxicity, describe the clinical characteristics, and determine the renal and clinical outcomes in adults with solid tumors. A retrospective, analytical cohort study was conducted on patients aged 18 years or older diagnosed with any solid tumor who had received at least one cycle of platinum-based chemotherapy over a 5-year period. AKI was defined and classified according to the KDIGO 2012 criteria. Demographic variables, comorbidities, electrolyte disturbance, tumor type, treatment regimen, and cumulative dose were collected. The frequency of nephrotoxicity by drug was estimated, and outcomes such as development of electrolyte disturbance, chronic kidney disease, need for renal replacement therapy, regimen modifications/discontinuation, and mortality at 120 days from the initiation of the platinum agent were examined. A total of 114 patients were included in the study. Testicular cancer was the most frequent neoplasm (29.8%). AKI occurred in 31.6%, while electrolyte imbalances were documented in 35.1% of patients. Renal replacement therapy was required in 7.9%, and 7.0% developed chronic kidney disease. Treatment discontinuation occurred in 7.0% of the study population, while dose modification was necessary in 11.4%. Overall 120 days mortality was 1.8% and did not differ between groups, whereas chronic kidney disease, dose modification and treatment discontinuation were significantly more frequent among patients who developed AKI. AKI was frequent even in a young population with preserved baseline renal function and a low prevalence of traditional renal risk factors. Although short-term mortality did not differ, acute kidney injury was associated with chronic kidney disease, renal replacement therapy, dose modification and treatment discontinuation, indicating that the clinical burden of platinum nephrotoxicity extends beyond short-term increases in serum creatinine and affects the delivery of cancer treatment.