The Effect of Intravenous Mannitol Combined With Normal Saline in Preventing Cisplatin-Induced Nephrotoxicity: A Randomized, Double-Blind, Placebo-Controlled Trial
PURPOSENephrotoxicity is a major dose-limiting toxicity among patients with cancer who were treated with cisplatin. Although no standard approach is available to prevent cisplatin-induced nephrotoxicity, administering intravenous isotonic saline is recommended. Additionally, mannitol combined with h...
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
American Society of Clinical Oncology
2022-03-01
|
| Series: | JCO Global Oncology |
| Online Access: | https://ascopubs.org/doi/10.1200/GO.21.00275 |
| _version_ | 1811304059577040896 |
|---|---|
| author | Panot Sainamthip Siriwimon Saichaemchan Bancha Satirapoj Naiyarat Prasongsook |
| author_facet | Panot Sainamthip Siriwimon Saichaemchan Bancha Satirapoj Naiyarat Prasongsook |
| author_sort | Panot Sainamthip |
| collection | DOAJ |
| description | PURPOSENephrotoxicity is a major dose-limiting toxicity among patients with cancer who were treated with cisplatin. Although no standard approach is available to prevent cisplatin-induced nephrotoxicity, administering intravenous isotonic saline is recommended. Additionally, mannitol combined with hydration has been evaluated, but none of them have been established. Our study aimed to determine the efficacy of mannitol combined hydration to prevent cisplatin-induced nephrotoxicity.PATIENTS AND METHODSThis study was a phase II, randomized, placebo-controlled design. All patients with solid cancers who were treated with cisplatin (n = 48) were randomly assigned to receive either placebo (n = 25) or 20 g of mannitol (n = 23) after completing 2 L of prehydration and receiving cisplatin. Serum creatinine, blood urea nitrogen, electrolyte, and glomerular filtration rate (GFR) were measured at baseline and days 2 and 7. Moreover, GFR was calculated based on the 24-hour urine creatinine clearance rate to assess renal function at baseline and 48 hours after receiving cisplatin. Severity of nausea and vomiting was evaluated using Common Terminology Criteria for Adverse Events.RESULTSNo difference was found regarding baseline characteristics between the two groups. Seven of 23 patients (37.4%) in the mannitol group and 10 of 25 patients (40%) in the placebo group increased serum creatinine level ≥ 0.3 mg/dL at 48 hours after intervention (P value = .48). Patients receiving mannitol exhibited significantly lower incidence of 24-hour urine GFR below 60 mL/min/1.73 m than those in the placebo group (13.6% v 48.0% in the placebo group; P value = .012). Univariate analysis showed the greatest benefit for administering mannitol among patients receiving cisplatin > 80 mg/m2, or patients receiving concomitant radiation.CONCLUSIONMannitol combined with hydration significantly prevented cisplatin-induced nephrotoxicity. Additionally, mannitol should be particularly considered among patients with cancer, treated with cisplatin > 80 mg/m2, or patients receiving concomitant radiation. |
| first_indexed | 2024-04-13T08:00:04Z |
| format | Article |
| id | doaj.art-7dca92994a0e43299e7f52a0aca6d66e |
| institution | Directory Open Access Journal |
| issn | 2687-8941 |
| language | English |
| last_indexed | 2024-04-13T08:00:04Z |
| publishDate | 2022-03-01 |
| publisher | American Society of Clinical Oncology |
| record_format | Article |
| series | JCO Global Oncology |
| spelling | doaj.art-7dca92994a0e43299e7f52a0aca6d66e2022-12-22T02:55:18ZengAmerican Society of Clinical OncologyJCO Global Oncology2687-89412022-03-01810.1200/GO.21.00275The Effect of Intravenous Mannitol Combined With Normal Saline in Preventing Cisplatin-Induced Nephrotoxicity: A Randomized, Double-Blind, Placebo-Controlled TrialPanot Sainamthip0Siriwimon Saichaemchan1Bancha Satirapoj2Naiyarat Prasongsook3Division of Medical Oncology, Department of Medicine, Phramongkutklao Hospital, College of Medicine, Bangkok, ThailandDivision of Medical Oncology, Department of Medicine, Phramongkutklao Hospital, College of Medicine, Bangkok, ThailandDivision of Nephrology, Department of Medicine, Phramongkutklao Hospital, College of Medicine, Bangkok, ThailandDivision of Medical Oncology, Department of Medicine, Phramongkutklao Hospital, College of Medicine, Bangkok, ThailandPURPOSENephrotoxicity is a major dose-limiting toxicity among patients with cancer who were treated with cisplatin. Although no standard approach is available to prevent cisplatin-induced nephrotoxicity, administering intravenous isotonic saline is recommended. Additionally, mannitol combined with hydration has been evaluated, but none of them have been established. Our study aimed to determine the efficacy of mannitol combined hydration to prevent cisplatin-induced nephrotoxicity.PATIENTS AND METHODSThis study was a phase II, randomized, placebo-controlled design. All patients with solid cancers who were treated with cisplatin (n = 48) were randomly assigned to receive either placebo (n = 25) or 20 g of mannitol (n = 23) after completing 2 L of prehydration and receiving cisplatin. Serum creatinine, blood urea nitrogen, electrolyte, and glomerular filtration rate (GFR) were measured at baseline and days 2 and 7. Moreover, GFR was calculated based on the 24-hour urine creatinine clearance rate to assess renal function at baseline and 48 hours after receiving cisplatin. Severity of nausea and vomiting was evaluated using Common Terminology Criteria for Adverse Events.RESULTSNo difference was found regarding baseline characteristics between the two groups. Seven of 23 patients (37.4%) in the mannitol group and 10 of 25 patients (40%) in the placebo group increased serum creatinine level ≥ 0.3 mg/dL at 48 hours after intervention (P value = .48). Patients receiving mannitol exhibited significantly lower incidence of 24-hour urine GFR below 60 mL/min/1.73 m than those in the placebo group (13.6% v 48.0% in the placebo group; P value = .012). Univariate analysis showed the greatest benefit for administering mannitol among patients receiving cisplatin > 80 mg/m2, or patients receiving concomitant radiation.CONCLUSIONMannitol combined with hydration significantly prevented cisplatin-induced nephrotoxicity. Additionally, mannitol should be particularly considered among patients with cancer, treated with cisplatin > 80 mg/m2, or patients receiving concomitant radiation.https://ascopubs.org/doi/10.1200/GO.21.00275 |
| spellingShingle | Panot Sainamthip Siriwimon Saichaemchan Bancha Satirapoj Naiyarat Prasongsook The Effect of Intravenous Mannitol Combined With Normal Saline in Preventing Cisplatin-Induced Nephrotoxicity: A Randomized, Double-Blind, Placebo-Controlled Trial JCO Global Oncology |
| title | The Effect of Intravenous Mannitol Combined With Normal Saline in Preventing Cisplatin-Induced Nephrotoxicity: A Randomized, Double-Blind, Placebo-Controlled Trial |
| title_full | The Effect of Intravenous Mannitol Combined With Normal Saline in Preventing Cisplatin-Induced Nephrotoxicity: A Randomized, Double-Blind, Placebo-Controlled Trial |
| title_fullStr | The Effect of Intravenous Mannitol Combined With Normal Saline in Preventing Cisplatin-Induced Nephrotoxicity: A Randomized, Double-Blind, Placebo-Controlled Trial |
| title_full_unstemmed | The Effect of Intravenous Mannitol Combined With Normal Saline in Preventing Cisplatin-Induced Nephrotoxicity: A Randomized, Double-Blind, Placebo-Controlled Trial |
| title_short | The Effect of Intravenous Mannitol Combined With Normal Saline in Preventing Cisplatin-Induced Nephrotoxicity: A Randomized, Double-Blind, Placebo-Controlled Trial |
| title_sort | effect of intravenous mannitol combined with normal saline in preventing cisplatin induced nephrotoxicity a randomized double blind placebo controlled trial |
| url | https://ascopubs.org/doi/10.1200/GO.21.00275 |
| work_keys_str_mv | AT panotsainamthip theeffectofintravenousmannitolcombinedwithnormalsalineinpreventingcisplatininducednephrotoxicityarandomizeddoubleblindplacebocontrolledtrial AT siriwimonsaichaemchan theeffectofintravenousmannitolcombinedwithnormalsalineinpreventingcisplatininducednephrotoxicityarandomizeddoubleblindplacebocontrolledtrial AT banchasatirapoj theeffectofintravenousmannitolcombinedwithnormalsalineinpreventingcisplatininducednephrotoxicityarandomizeddoubleblindplacebocontrolledtrial AT naiyaratprasongsook theeffectofintravenousmannitolcombinedwithnormalsalineinpreventingcisplatininducednephrotoxicityarandomizeddoubleblindplacebocontrolledtrial AT panotsainamthip effectofintravenousmannitolcombinedwithnormalsalineinpreventingcisplatininducednephrotoxicityarandomizeddoubleblindplacebocontrolledtrial AT siriwimonsaichaemchan effectofintravenousmannitolcombinedwithnormalsalineinpreventingcisplatininducednephrotoxicityarandomizeddoubleblindplacebocontrolledtrial AT banchasatirapoj effectofintravenousmannitolcombinedwithnormalsalineinpreventingcisplatininducednephrotoxicityarandomizeddoubleblindplacebocontrolledtrial AT naiyaratprasongsook effectofintravenousmannitolcombinedwithnormalsalineinpreventingcisplatininducednephrotoxicityarandomizeddoubleblindplacebocontrolledtrial |