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Drugs. 2019 Sep;79(14):1567-1582. doi: 10.1007/s40265-019-01182-1.

Prevention of Cisplatin-Induced Acute Kidney Injury: A Systematic Review and Meta-Analysis.

Author information

1
Nephrology Department, CHRU Lille, University of Lille, 59000, Lille, France. aghiles.hamroun@gmail.com.
2
Nephrology Department, CHRU Lille, University of Lille, 59000, Lille, France.
3
Faculty of Medicine, University of Paris Saclay, Paris, France.
4
Centre for Research in Epidemiology and Population Health (CESP), Paris Saclay University, Paris Sud University, Versailles Saint Quentin University, INSERM UMRS 1018, 94807, Villejuif, France.
5
Nephrology Department, CH Beuvry, Béthune, France.
6
Department of Toxicology and Genetic Pathologies, CHRU Lille, 59000, Lille, France.
7
EA 4483-IMPECS-IMPact of Environmental ChemicalS on Human Health, Medicine Faculty, Research Department, University of Lille, 59045, Lille, France.
8
Pulmonary and Thoracic Oncology Department, University of Lille, INSERM U1189 OncoThAI, 59000, Lille, France.
9
INSERM, UMR995, 59000, Lille, France.

Abstract

PURPOSE:

Cisplatin-induced acute kidney injury (CIA) is a serious adverse event that affects 20-40% of exposed patients, despite any implemented precaution to avoid it. The aim of this work was therefore to identify a relevant nephroprotective method for CIA.

METHODS:

We searched Pubmed, Embase, and Web of Science from 1 January 1978 to 1 June 2018, without language restriction. All studies (observational and interventional) assessing a CIA prevention method for adults receiving at least one course of cisplatin were eligible. The primary outcome was acute nephrotoxicity, as defined by the AKI-KDIGO classification (2012). The odds ratio and corresponding 95% confidence interval were used to assess the associations. We used narrative synthesis in case of heterogeneity regarding intervention, population, or outcome. When possible, a random-effects model was used to pool studies. The heterogeneity between studies was quantified (I2), and multiple meta-regressions were carried out to identify potential confounders.

RESULTS:

Within 4520 eligible studies, 51 articles fulfilling the selection criteria were included in the review, assessing 21 different prevention methods. A meta-analysis could only be performed on the 15 observational studies concerning magnesium supplementation (1841 patients), and showed a significant nephroprotective effect for all combined grades of CIA (OR 0.24, [0.19-0.32], I2 = 0.0%). This significant nephroprotective effect was also observed for grades 2 and 3 CIA (OR 0.22, [0.14-0.33], I2 = 0.0% and OR 0.25, [0.08-0.76], I2 = 0.0%, respectively).

CONCLUSION:

While no method of prevention had so far demonstrated its indisputable efficacy, our results highlight the potential protective effect of magnesium supplementation on cisplatin-induced acute nephrotoxicity.

TRIAL REGISTRATION:

This study is registered in PROSPERO, CRD42018090612.

PMID:
31429065
DOI:
10.1007/s40265-019-01182-1

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