Abstract: SA-PO024

Hydration Protocols with Cisplatin: Need for Consensus and Cost Curtailment

Session Information

Category: Acute Kidney Injury

  • 003 AKI: Clinical and Translational

Authors

  • Manohar, Sandhya, Mayo Clinic, Rochester, Minnesota, United States
  • Kittanamongkolchai, Wonngarm, Mayo Clinic, Rochester, Minnesota, United States
  • Mcdonald, Jennifer, Mayo Clinic, Rochester, Minnesota, United States
  • Betcher, Jeffrey A., Mayo Clinic, Rochester, Minnesota, United States
  • Finnes, Heidi Diann, Mayo Clinic, Rochester, Minnesota, United States
  • Leung, Nelson, Mayo Clinic, Rochester, Minnesota, United States
Background

Platinum based drugs use is often restricted due to the high risk of nephrotoxicity. The incidence of nephrotoxicity for Cisplatin is reported to be 25-30%. Many nephroprotective measures have been studied with hydration being the most commonly used. We sought to compare the incidence of Acute Kidney injury (AKI) at two large tertiary referral centers that use different nephroprotective protocols

Methods

We retrospectively reviewed all adult patients that received first dose of Cisplatin at Mayo Clinic Rochester (MCR) and Arizona (MCA) from 2010-2015 and had at least one creatinine value 7 days before and 72 hours after the drug administration. MCR utilizes a limited dose dependent hydration fluid with mannitol in the bag containing Cisplatin whereas MCA uses a liberal 1 liter pre- and post-hydration without mannitol.

Results

Out of the 2188 patients that had received Cisplatin at the 2 centers, only 191 patients met the inclusion criteria. Among them the overall incidence of AKI was 9.4% (18/191) with MCR having 10% (11/110) and MCA 8.6% (7/81) and the difference was not statistically significant. Only one patient had AKIN Stage 2 AKI and the rest were AKIN Stage 1. The average dose of Cisplatin received was higher in MCA (85.5 mg vs 74.9 mg) which was statistically significant (p 0.05). The average dose of fluids was 1316.7 ml (SD 615) in the 2 cohorts. There was no significant difference in the age, gender, history of chronic kidney disease, diabetes, hypertension, baseline creatinine, 30 day hospitalization and time to death after initiating chemotherapy among the two cohorts.

Conclusion

Our study showed that despite the marked differences in the nephroprotective protocols used at each of the center there was no difference in the AKI rate. In this time when the need for cost effective medicine is paramount we must try to be judicious in the drugs we use. We have since converged our Cisplatin hydration protocol, to be dose directed and without routine mannitol use, across the Mayo Clinic enterprise.