Risk Factors for Severe Hyponatremia Related to Cisplatin: A Retrospective Case-Control Study

Abstract

Onset of severe hyponatremia following cisplatin (CDDP) administration has been previously reported. However, the risk factors associated with hyponatremia still remain unclear. We conducted a retrospective, single-center, case-control study to identify independent risk factors of severe hyponatremia in patients with various types of cancers. Adult patients who received intravenous CDDP administration between January 2012 and December 2017 met the inclusion criteria. The investigators recorded patients' demographics and clinical information retrospectively, and assessed the lowest serum sodium level within 21 d of the first CDDP administration. Risk factors for grade ≥3 hyponatremia were examined via a logistic regression analysis. Among a total of 472 patients, fifty patients (10.6%) developed grade ≥3 hyponatremia. Univariate analysis revealed that age (≥65 years), presence of small cell lung or esophageal cancer, and lower sodium concentrations in the serum (<138 mEq/L) were significantly associated with grade 3 and 4 hyponatremia. Additionally, multivariable logistic regression analysis showed that the presence of small cell lung cancer (adjusted odds ratio, 3.26; 95% confidence interval (CI), 1.07-10.00) and lower sodium concentrations in the serum (<138 mEq/L) (adjusted odds ratio, 6.18; 95%CI, 3.21-11.90) were independent risk factors of grade 3 and 4 hyponatremia. Thus, serum sodium concentrations in patients with these risk factors should be closely monitored after CDDP administration.

Low-dose cyclophosphamide-induced hyponatremia in primary breast cancer

“…On the other hand, lower serum sodium level at baseline and younger age were shown to be independent possible risk factors. A retrospective study of risk factors of cisplatinrelated hyponatremia also reported that lower baseline serum sodium concentration (<138 mEq/L) was a risk factor for severe hyponatremia [17]. Our observation indicated that patients who had pretreatment lower sodium concentration may be likely to result in hyponatremia (<135 mEq/L) even with small decline of its level after hypotonic electrolyte infusion following CPA administration.…”

Protective Effect of Panduratin A on Cisplatin-Induced Apoptosis of Human Renal Proximal Tubular Cells and Acute Kidney Injury in Mice

“…5) However, approximately one out of three patients receiving cisplatin treatment suffers from nephrotoxicity 6,7) and electrolyte imbalance. 8,9) Cisplatin-induced nephrotoxicity is characterized by proximal tubule injury, vascular injury and inflammation. 4) Accumulation of cisplatin in renal cells induces multiple pathways that promote cell death.…”

Cancer therapy-induced hyponatremia: A case-illustrated review

“…7,8 There is limited data to quantify the overall incidence of hyponatremia in patients receiving platinum-based anticancer agents; however, in a recent retrospective study of 472 patients who were treated with cisplatin for various cancers, 8.9% and 1.7% developed grade 3 (serum sodium 120–129 mEq/L) and grade 4 (<120 mEq/L) hyponatremia, respectively. 9 Risk factors for grade 3 and 4 hyponatremia determined via multivariable regression included the presence of small cell lung cancer (adjusted odds ratio, 3.26; 95% confidence interval (CI), 1.07–10.00)) and lower baseline serum sodium (<138 mEq/L, (adjusted odds ratio, 6.18; 95%CI, 3.21–11.90)). Carboplatin and oxaliplatin may have a lower incidence of hyponatremia relative to cisplatin containing regimens.…”