Profiles and preventive strategies of nephrotoxicity among adult patients receiving cisplatin based regimens at Kenyatta national hospital
Abstract
Background: The use of cisplatin in the management of cancer is associated with
nephrotoxicity. There is scant literature on the profiles and preventive strategies against renal
toxicities in Kenyatta National Hospital.
Study Design, Setting and Methodology: Retrospective cohort study design using simple
random sampling was used to find out the renal toxicity profiles among three hundred and sixty
seven adult patients in Kenyatta National Hospital, radiotherapy clinic. Preventive strategies
employed to prevent development of renal toxicities were also studied.
Results: There was female preponderance at 62.6%. The median age of the study population was
51 years (range 18-91). Cervical cancer (41.5%) was commonest type of cancer where cisplatin
based regimen were used. Nephrotoxicity was found to be 58.5% and the profiles of
nephrotoxicity increased with the number of cycles. The major risk factors for development of
nephrotoxicity were cumulative dose of cisplatin above 200mg/m2 (66.4%), radio contrast
exposure (51.2 %) and electrolyte abnormalities (12.2 %). Most patients experienced grade 2
nephrotoxicity with mean glomerular filtration rate of 59.3 ml/min/1.73m2 (±20.6). Threequarters
of the patients developed nephrotoxicity during the follow-up on treatment, with the
majority (80%) being older than 50 years of age. Electrolyte abnormalities including
hypokalaemia (22%) and hypocalcaemia (0.5 %) were also encountered. Preventive strategies
against development of nephrotoxicity included postponement of cisplatin dose due to deranged
renal function (33.2%), change of cisplatin to carboplatin (3.5%), oral hydration (100%) and
intravenous hydration with normal saline (100%). Whereas the change of dose from cisplatin to
carboplatin was found not to confer prevention against nephrotoxicity (p=0.181), postponing the
dose of cisplatin did (p<0.0001).
(p=0.486).
Conclusion: Despite the preventive strategies for the development of nephrotoxicity, more than
half exhibited nephrotoxic profiles, suggesting that better ways of preventing nephrotoxicity
ought to be sought.