Nephrotoxicity of cisplatin combination chemotherapy in thoracic malignancy patients with CKD risk factors.
Nephrotoxicity of cisplatin combination chemotherapy in thoracic malignancy patients with CKD risk factors.
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DOI：
10.1186/s12885-016-2271-8
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发表时间：
2016-03-15
期刊：
影响因子：
3.8
通讯作者：
Narita I
中科院分区：
文献类型：
--
作者：
Sato K;Watanabe S;Ohtsubo A;Shoji S;Ishikawa D;Tanaka T;Nozaki K;Kondo R;Okajima M;Miura S;Tanaka J;Sakagami T;Koya T;Kagamu H;Yoshizawa H;Narita I
肾毒性是限制顺铂安全给药剂量的主要副作用，也是接受顺铂联合化疗的癌症患者面临的临床问题。最近的证据表明，慢性肾脏病(CKD)患者发生急性肾损伤(AKI)的风险增加。本研究旨在评估CKD危险因素在接受顺铂治疗的患者中的患病率，并评估CKD危险因素与顺铂诱导的AKI的相关性。我们回顾分析了84例采用顺铂联合化疗治疗胸部恶性肿瘤的临床资料。AKI定义为估计肾小球滤过率(EGFR) >； 较基线下降25%， >； 升高0.3%mg/dl或 ≥ 升高1.5%。84名患者中有80名(95.2%)至少有一个CKD的危险因素。所有入选患者均接受顺铂水化、镁补充和甘露醇治疗。顺铂致急性肾损伤18例(21.4%)。单因素分析显示，心脏病和非甾体抗炎药的使用与顺铂肾毒性有关(OR值分别为6和3.56，95%可信区间分别为1.2 1~2 9.87和1.11~11.39，p = 0.0 4和p = 0.0 4)。多因素分析显示，同时存在上述两种危险因素的患者发生顺铂肾毒性的比例显著增加(OR13.64，95%CI 1.11~326.83，p = 0.04)。CKD危险因素越多的患者发生顺铂所致AKI的风险越大。我们应该考虑避免对有CKD危险因素的患者使用顺铂，特别是心脏病和非甾体抗炎药的使用。本文的在线版本(doi：10.1186/s12885-0162271-8)包含补充材料，授权用户可以使用。
Nephrotoxicity is the major side effect that limits the dose of cisplatin that can be safely administered, and it is a clinical problem in cancer patients who received cisplatin combination chemotherapy. Recent evidence has demonstrated that patients with chronic kidney disease (CKD) have an increased risk of developing acute kidney injury (AKI). The present study was conducted to evaluate the prevalence of CKD risk factors in patients who received cisplatin and to assess the correlation between CKD risk factors and cisplatin-induced AKI. We retrospectively analyzed 84 patients treated with cisplatin combination chemotherapy for thoracic malignancies. AKI was defined as a decrease in the estimated glomerular filtration rate (eGFR) > 25 % from base line, an increase in the serum creatinine (sCre) level of > 0.3 mg/dl or ≥ 1.5 times the baseline level. Eighty of the 84 patients (95.2 %) had at least one risk factor for CKD. All enrolled patients received cisplatin with hydration, magnesium supplementation and mannitol. Cisplatin-induced AKI was observed in 18 patients (21.4 %). Univariate analysis revealed that cardiac disease and use of non-steroidal anti-inflammatory drugs (NSAIDs) were associated with cisplatin-induced nephrotoxicity (odds ratios [OR] 6 and 3.56, 95 % confidence intervals [CI] 1.21–29.87 and 1.11–11.39, p = 0.04 and p = 0.04, respectively). Multivariate analysis revealed that cisplatin nephrotoxicity occurred significantly more often in patients with both risk factors (OR 13.64, 95 % CI 1.11–326.83, p = 0.04). Patients with more risk factors for CKD tended to have a greater risk of developing cisplatin-induced AKI. We should consider avoiding administration of cisplatin to patients with CKD risk factors, particularly cardiac disease and NSAID use. The online version of this article (doi:10.1186/s12885-016-2271-8) contains supplementary material, which is available to authorized users.