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.