Cisplatin-induced nephrotoxicity in an outpatient setting.

Background: The use of cisplatin is limited by the development of nephrotoxicity, with an incidence approaching 30%. It is unclear if a risk prediction score can effectively predict the development of nephrotoxicity throughout all cycles of cisplatin therapy among outpatients.

Methods: Retrospective, observational study evaluating adult patients receiving cisplatin in outpatient infusion centers from January 2009 to November 2019 (n = 186). A risk prediction score consisting of patient age, cisplatin dose, hypertension, and serum albumin was calculated to predict the risk of cisplatin-induced nephrotoxicity.

Results: The incidence of nephrotoxicity was 23.7% overall, with 8.1% of patients developing cisplatin-induced nephrotoxicity after the first dose. Patients who developed nephrotoxicity had a higher mean risk prediction score compared to patients who did not have nephrotoxicity (4.0 ± 2.0 versus 2.9 ± 2.1, p = 0.004, respectively). Multivariate logistic regression demonstrated each 1-point increase in the risk prediction score increased the odds of nephrotoxicity by 26.5% (OR: 1.27; 95% CI: 1.02-1.57, p = 0.034). Presence of diabetes mellitus increased the odds of cisplatin-induced nephrotoxicity (OR 3.66; 95% CI: 1.43-9.33, p = 0.007), whereas receipt of greater than or equal to 1 liter of 0.9% sodium chloride was protective, decreasing the odds of developing nephrotoxicity by 25%.

Conclusion: By identifying patients at the highest risk of cisplatin-induced nephrotoxicity, providers can individualize risk reduction strategies. The use of a risk prediction model successfully predicted the risk of nephrotoxicity throughout all cycles of cisplatin in an outpatient setting.