Cisplatin-Induced Nephrotoxicity in an Outpatient Setting.

BACKGROUND The use of cisplatin is limited by the development of nephrotoxicity, with an incidence approaching 30%. It is unclear if a risk prediction score can effectively predict the development of nephrotoxicity throughout all cycles of cisplatin therapy among outpatients. METHODS Retrospective, observational study evaluating adult patients receiving cisplatin in outpatient infusion centers from January 2009 to November 2019 (n = 186). A risk prediction score consisting of patient age, cisplatin dose, hypertension, and serum albumin was calculated to predict the risk of cisplatin-induced nephrotoxicity. RESULTS The incidence of nephrotoxicity was 23.7% overall, with 8.1% of patients developing cisplatin-induced nephrotoxicity after the first dose. Patients who developed nephrotoxicity had a higher mean risk prediction score compared to patients who did not have nephrotoxicity (4.0 ± 2.0 versus 2.9 ± 2.1, p = 0.004, respectively). Multivariate logistic regression demonstrated each 1-point increase in the risk prediction score increased the odds of nephrotoxicity by 26.5% (OR: 1.27; 95% CI: 1.02-1.57, p = 0.034). Presence of diabetes mellitus increased the odds of cisplatin-induced nephrotoxicity (OR 3.66; 95% CI: 1.43-9.33, p = 0.007), whereas receipt of greater than or equal to 1 liter of 0.9% sodium chloride was protective, decreasing the odds of developing nephrotoxicity by 25%. CONCLUSION By identifying patients at the highest risk of cisplatin-induced nephrotoxicity, providers can individualize risk reduction strategies. The use of a risk prediction model successfully predicted the risk of nephrotoxicity throughout all cycles of cisplatin in an outpatient setting.