Protective Effect of Forced Hydration with Isotonic Saline, Potassium Chloride and Magnesium Sulfate on Cisplatin Nephrotoxicity: An Initial Evaluation

Nephrotoxicity is one of the major side-effects of cisplatin that has been seen in about 20% of treated patients. The aim of this study was to assess the effectiveness of a forced hydration protocol comprised of isotonic saline, potassium chloride (KCl) and magnesium sulfate (MgSO4) on prevention of cisplatin nephrotoxicity. This cross sectional prospective study was performed on cancer patients treated in Shafa Hospital, Ahvaz, Iran from November 2009 to March 2010. The patients were under at least 50 mg/m2 cisplatin. All patients received 1000 mL isotonic saline plus 20 mEq of KCl and 2 g of MgSO4 during 2-3 hours before, and 500 mL of the same solution over the two hours after administration of cisplatin. The prescribed dose of the solution was to the extent facilitating a urine flow of at least 100 mL/h for two hours prior to chemotherapy and 2 hours post-chemotherapy. Cisplatin nephrotoxicity was defined as an increase in the SCr equal or over 0.5 mg/dL during the 5 day follow-up post-chemotherapy. A total of 76 patients (48 men and 28 women with mean (SD) age of 51.0 (17.6) years) were studied. Mean cumulative cisplatin dose was 86.7 (43.1) mg/m2. Hypokalemia and hypomagnesemia were not observed in any patient. Cisplatin nephrotoxicity (increase of creatinine) was developed in 5 patients (6.6%). The mean dose of cisplatin in patients with and without nephrotoxicity was 83 and 86.97 mg respectively which showed no significant difference between them (P = 0.8). The new protocol was able to decrease the rate of cisplatin nephrotoxicity from about 20% to 6.6%. Further case control studies with larger sample sizes are recommended to evaluate the effectiveness of this protocol.