PGY2 Oncology Pharmacy Resident University of Virginia Health Forest, Virginia, United States
Poster Abstract:
Background: The introduction of cisplatin has revolutionized treatment for several solid tumor malignancies. However, the clinical utility of cisplatin is dampened by its dose-limiting nephrotoxicity. Cisplatin-induced nephrotoxicity primary arises from renal tubular accumulation of the drug, leading to acute kidney injury (AKI). The severity of AKI ranges from subclinical changes in renal function to severe AKI requiring dialysis. The management and prevention of cisplatin-induced nephrotoxicity involves intravenous fluid administration to facilitate cisplatin excretion and maintain adequate hydration, electrolyte supplementation, and control of other potential nephrotoxic exposures. Hydration protocols differ significantly between health systems due to the lack of guidance surrounding cisplatin hydration. In 2019, the University of Virginia (UVA) implemented changes to hydration protocols for patients receiving cisplatin with the goal of reducing infusion chair time. Historical treatment plans involved pre- and post-hydration containing potassium and magnesium on day 1 of treatment. Currently, pre- and concurrent hydration is included on day 1 of treatment without electrolyte supplementation, followed by the use of hydration only on day 2 in thoracic oncology patients.
Objective: This study will evaluate whether the prevalence of AKI in patients receiving cisplatin has changed since the implementation of a new hydration protocol in 2019.
Methods: This retrospective, single-center study will include a two-cohort comparison of AKI prevalence during treatment with cisplatin at doses >50 mg/m2. Cohort 1 will include pre-2019 patients who received cisplatin for treatment of solid tumor malignancies at UVA Health. Cohort 2 will be divided into 2 groups: Group A, with 2019 – current patients who received cisplatin for treatment of non-thoracic malignancies at UVA Health, and Group B, with 2019 – current patients who received cisplatin for treatment of thoracic malignancies at UVA Health. Data for each cohort will be obtained through an EHR data report and manual chart review will be conducted. The data will be analyzed to determine AKI prevalence per KDIGO definitions, and to assess the severity of renal dysfunction, the percentage of patients to require switching to an alternative platinum (e.g., carboplatin) or dose reduction in cisplatin due to AKI, the incidence of treatment discontinuation due to AKI, and the need for acute hemodialysis or hospitalization due to AKI attributed to cisplatin therapy.
Results: Results are pending. Discussion/
Conclusion: Findings are pending.
References (must also be included in final poster): Ruggiero A, Rizzo D, Trombatore G, Maurizi P, Riccardi R. The ability of mannitol to decrease cisplatin-induced nephrotoxicity in children: real or not?. Cancer Chemother Pharmacol. 2016;77(1):19-26. doi:10.1007/s00280-015-2913-6 Burns CV, Edwin SB, Szpunar S, Forman J. Cisplatin-induced nephrotoxicity in an outpatient setting. Pharmacotherapy. 2021;41(2):184-190. doi:10.1002/phar.2500 Crona DJ, Faso A, Nishijima TF, McGraw KA, Galsky MD, Milowsky MI. A Systematic Review of Strategies to Prevent Cisplatin-Induced Nephrotoxicity. Oncologist. 2017;22(5):609-619. doi:10.1634/theoncologist.2016-0319 Duffy EA, Fitzgerald W, Boyle K, Rohatgi R. Nephrotoxicity: Evidence in Patients Receiving Cisplatin Therapy. Clin J Oncol Nurs. 2018;22(2):175-183. doi:10.1188/18.CJON.175-183 Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract. 2012;120(4):c179-c184. doi:10.1159/000339789
