Renal function impairment in cervical cancer patients treated with cisplatin-based chemoradiation: A review of medical records in a Zimbabwean outpatient department

Abstract

Background There is a potential increase in risk of renal function impairment among patients with invasive cervical cancer (ICC) who are HIV-positive and treated with cisplatin-based concurrent chemoradiation (CCRT). This concern is due to overlapping nephrotoxicity of the drugs, and nephropathy from the diseases themselves. There is limited literature available for the short-term renal outcomes for HIV-positive patients with ICC during routine clinical management. This study aimed to assess if HIV-infection increased the risk of renal impairment in ICC patients treated with CCRT, and explore the respective risk factors. Materials and methods This was a retrospective review of records of ICC patients treated with at least one cycle of weekly cisplatin during CCRT at the Parirenyatwa Radiotherapy Center from January 2017-December 2018. The RIFLE criteria were used to classify renal impairment. Analyses were performed with Fisher’s Exact tests, Wilcoxon rank sum tests. Odds ratios (OR) were generated using logistic regression. All statistical tests were 2-sided at a 5% level of significance. Results Seventy-two eligible patients were identified, 32 (44.44%) were HIV-positive. HIV-positive patients were younger (p = 0.002), had lower albumin levels (p = 0.014) and received lower cisplatin doses (p = 0.044). The mean percent reduction in estimated glomerular filtration rate (eGFR) from baseline was -19% (95% CI: -25.9% to -13.2%) for all patients. Thirty-one (43.1%) patients experienced renal impairment, 50% and 37.5% of HIV-positive and -negative patients respectively (p = 0.287). HIV-infection was associated with an adjusted OR of 1.16 (95% CI 0.35–3.43, p = 0.769). Baseline eGFR< 60ml/min was the only independent predictor of renal impairment, OR 0.25 (95% CI: 0.07–0.85). Baseline eGFR<60ml/min was also associated with receipt of lower cisplatin doses (p = 0.044). Conclusion HIV-infection was not associated with elevated risk of renal impairment. Patients with an eGFR<60ml/min appear to be managed more cautiously reducing their risk for renal impairment during cisplatin therapy. The high prevalence of renal impairment in this population suggests the need for optimization of pre-treatment protocols.

Platinum-based drug-induced depletion of amino acids in the kidneys and liver

“…The toxicities related to the application of CDDP are usually dose dependent. Overdoses of CDDP significantly increase the percentage of morbidity and/or mortality in patients ( 3 ) and the clinical features associated with CDDP overdose include various side effects of therapy, such as nausea and vomiting, renal insufficiency, electrolyte abnormalities, ototoxicity, peripheral neuropathy, hepatotoxicity, and retinopathy ( 4 – 10 ). DNA repair has a crucial role in controlling the negative side effects of platinum drug therapy ( 11 , 12 ).…”

Assessment of cisplatin-induced nephrotoxicity and its associated factors among cervical cancer patients in the leading tertiary hospital in Kenya

“…13 A Zimbabwe study showed a prevalence rate of 43.1% in patients with invasive cervical cancer. 9 Furthermore, another study in South Africa showed a prevalence of 17%. 15 These differences can be attributed to the difference in the study population.…”

“…Contrastingly, other studies HIV was not to be statistically significant. 9,20 HIV being a risk factor for cervical cancer can also increase the risk of cisplatin nephrotoxicity especially when co-administered with tenofovir.…”

“…8 A previous study carried out among cervical cancer patients reported that the range of cisplatin-induced nephrotoxicity in cervical cancer was 43.1%. 9 However, there are a lack of data about cisplatin-induced nephrotoxicity in cervical cancer in our Kenyan setting. Hence, this study aimed to assess the prevalence of cisplatin-induced nephrotoxicity and its associated factors among cervical cancer patients at the Kenyatta National Hospital.…”

Prevalence of renal insufficiency and factors associated among selected cancer patients on chemotherapy at Ocean Road Cancer Institute in Tanzania: a cross-sectional study

“…A study in Belgium by Janus et al (2010) reported a prevalence of 64% of RI among cancer patients. Another study in Brazil by Pontes et al (2014) reported a high prevalence (66%) of RI [ 4 , 6 ], and also a study that was done in Zimbabwe by Manyau et al (2021) in cervical cancer patients on cisplatin reported a high prevalence (43%) of RI among these patients [ 5 ]. The high prevalence of RI among cancer patients might be due to the disease (progression and metastasis) or anticancer treatments (chemotherapy and radiotherapy) [ 12 – 15 ].…”