Short hydration with 20 mEq of magnesium supplementation for lung cancer patients receiving cisplatin-based chemotherapy: a prospective study

Hase, Takashi; Miyazaki, Masaru; Ichikawa, Kazuya; Yogo, Naoyuki; Ozawa, Naoya; Hatta, Takahiro; Ando, Masahiko; Sato, Mitsuo; Kondo, Masashi; Yamada, Kiyofumi; Hasegawa, Yoshinori

doi:10.1007/s10147-020-01755-1

Cited by 15 publications

(17 citation statements)

References 38 publications

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“…This case report along with supporting documentation provided by both clinical and pre-clinical studies clearly demonstrate the effectiveness of IV magnesium before cisplatin in preventing acute kidney injury manifested by oliguria. We recommend that at least 2 g of magnesium be administered prior to cisplatin since a recent study by Uhm found that 1 g still resulted in 33% of patients developing hypomagnesium (57), while a study by Hase supported the use of 20 mEq/L or approximately 2.5 g. (62) Therefore, if we are to follow our oath to do no harm, it is imperative that IV magnesium administration with cisplatin become a "best practice" guideline at all oncology centers.…”

Section: Discussionmentioning

confidence: 99%

Case Report and Supporting Documentation: Acute Kidney Injury Manifested as Oliguria Is Reduced by Intravenous Magnesium Before Cisplatin

et al. 2021

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After more than four decades of post-approval, cisplatin is still an important treatment for numerous cancers. However, acute kidney injury (AKI), defined as significant impairment of renal filtration as discussed below, is the major limiting side effect of cisplatin, occurring in approximately 30% of patients (25–33% after the first course). Cisplatin also damages the kidneys’ ability to reabsorb magnesium in 40–100% of patients, with collateral health risks due to subsequent hypomagnesemia. Multiple methods and drugs have been proposed for preventing cisplatin-induced AKI, including saline infusion with or without mannitol, which has not always prevented AKI and has been found to activate a cellular stress response in renal tubular cells. While numerous reports and trials, as well as the National Comprehensive Cancer Network (NCCN), support premedication with magnesium and hydration, this practice has not been universally accepted. Many clinics administer intravenous magnesium (IV) only after identification of hypomagnesemia post-cisplatin treatment, thus placing patients at risk for AKI and chronic renal loss of magnesium. We present the following case report and additional supporting evidence identifying the immediate effect of IV magnesium prior to intraperitoneal cisplatin for cycle 4 because of documented hypomagnesemia resulting in normalization of oliguria, which had been experienced for the first three cycles. The patient subsequently requested and received IV magnesium before cisplatin for the next two cycles with continuation of normal urinary output. The effect of pretreatment with IV magnesium on urine output following cisplatin has not been previously reported and further supports pre-cisplatin administration. In addition, two recent meta-analyses of clinical trials and pre-clinical research are reviewed that demonstrate effectiveness of magnesium pretreatment to preventing AKI without reducing its chemotherapeutic efficacy. This case report with additional evidence supports the adoption of administration of 1–3 g IV magnesium before cisplatin as best practice to prevent cisplatin induced AKI and hypomagnesemia regardless of patient baseline serum magnesium levels.

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Section: Discussionmentioning

confidence: 99%

Case Report and Supporting Documentation: Acute Kidney Injury Manifested as Oliguria Is Reduced by Intravenous Magnesium Before Cisplatin

et al. 2021

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“…A review of studies reporting on nephrotoxicity with standard high-dose cisplatin has led to clinical practice guidelines recommending that 8-20 mEq of magnesium should be administered intravenously prior to standard high-dose cisplatin administration. 1 , 3 , 17 , 18 , 19 Minzi et al. 17 reported that 8 mEq of intravenous magnesium decreased the incidence of nephrotoxicity without serious side-effects.…”

Section: Introductionmentioning

confidence: 99%

“… 17 reported that 8 mEq of intravenous magnesium decreased the incidence of nephrotoxicity without serious side-effects. In addition, Hase and colleagues 19 demonstrated the safety and efficacy of an additional 20 mEq magnesium compared to 0.9% NaCl and mannitol for standard high-dose cisplatin regimens (≥60 mg/m 2 every 3-4 weeks). Moreover, Willox et al.…”

Section: Introductionmentioning

confidence: 99%

Preloading magnesium attenuates cisplatin-associated nephrotoxicity: pilot randomized controlled trial (PRAGMATIC study)

Suppadungsuk

Phitakwatchara²,

Reungwetwattana

et al. 2022

ESMO Open

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Background Cisplatin is one of the most potent chemotherapeutic drugs used in head and neck cancer treatment; however, nephrotoxicity is the major side-effect limiting usage. Magnesium supplementation has been reported to reduce risk in non-controlled studies. We investigated whether preloading with magnesium prevents nephrotoxicity with a low-dose weekly cisplatin regimen. Methods We carried out a prospective pilot, single-blinded, randomized controlled trial to compare cisplatin-associated acute kidney injury (cis-AKI) and acute kidney disease (cis-AKD) between two groups: intravenous 0.9% NaCl 500 ml + KCL 20 mEq over 4 h pre-cisplatin 40 mg/m 2 weekly for 7-8 weeks (control group) compared with additional 16 mEq magnesium added to the saline infusion (Mg group) in 30 head and neck cancer patients. Cis-AKI was defined as an increased serum creatinine (SCr) ≥ 0.3 mg/dl within 7 days and cis-AKD is an increased SCr ≥ 0.3 mg/dl between last SCr and baseline pre-chemotherapy SCr. Results The overall cisplatin tumor response rate and survival were comparable between groups. The baseline characteristics were comparable between groups, although SCr was lower in the controls (0.70 ± 0.17 versus 0.87 ± 0.17 mg/dl, P = 0.01). The incidence of cis-AKI was similar (4.6% versus 1.3%); however, the incidence of cis-AKD was higher for the control group (46.7% versus 6.7%, hazard ratio = 0.082, 95% confidence interval 0.008-0.79, P = 0.03). The time to develop cis-AKD was significantly shorter in the control group ( P = 0.007). Conclusions The magnesium-preloading regimen was safe and significantly showed a decreased incidence of cis-AKD. The encouraging results of our pilot study need to be confirmed in a large-scale randomized controlled trial.

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“…Previous studies have shown that Mg supplementation during CDDP-based chemotherapy correlated with the prevention of CDDP-induced nephrotoxicity [12][13][14]. However, these studies have used varying doses of Mg supplementation, demonstrating that 8 mEq [15][16][17], 20 mEq [18,19], and 40 mEq [12] of intravenous Mg supplementation all had preventive effects against CDDP-induced nephrotoxicity. Mg supplementation is most frequently administered at a dose of 8 mEq according to the National Comprehensive Cancer Network (NCCN) order template and/or the results of studies in Japan [15][16][17].…”

Section: Introductionmentioning

confidence: 99%

Preventive effect of 20 mEq and 8 mEq magnesium supplementation on cisplatin-induced nephrotoxicity: a propensity score–matched analysis

Miyoshi

Hayashi

Uoi

et al. 2022

Support Care Cancer

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The protective effect of magnesium (Mg) supplementation against cisplatin (CDDP)-induced nephrotoxicity has been widely described; however, the optimal dose of Mg supplementation is unclear. The aim of this study was to investigate whether 20 mEq of Mg supplementation is more effective than 8 mEq Mg in preventing CDDP-induced nephrotoxicity, as well as the associated risk factors, in cancer patients treated with CDDP-based chemotherapy. MethodsPooled data of 272 patients receiving 20 mEq or 8mEq Mg supplementation to CDDP-based chemotherapy from a multicenter, retrospective, observational study were compared using propensity score matching.Separate multivariate logistic regression analyses were used to identify the risk factors for renal failure induced by each treatment dose. ResultsThere was no signi cant difference in the incidence of CDDP-induced nephrotoxicity between the 8 mEq and 20 mEq groups (18.4% vs. 20.6%, P = 0.760). There was also no signi cant difference in the severity of nephrotoxicity, elevated serum creatinine levels, and decreased estimated creatinine clearance levels between the two groups. Cardiac disease and albumin levels were identi ed as independent risk factors for CDDPinduced nephrotoxicity. ConclusionWe did not nd an advantage of 20 mEq over 8 mEq Mg supplementation in terms of a preventive effect against CDDP-induced nephrotoxicity. The optimal dose of Mg supplementation for the prevention of CDDPinduced nephrotoxicity remains unknown, and further studies are warranted.

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Short hydration with 20 mEq of magnesium supplementation for lung cancer patients receiving cisplatin-based chemotherapy: a prospective study

Cited by 15 publications

References 38 publications

Case Report and Supporting Documentation: Acute Kidney Injury Manifested as Oliguria Is Reduced by Intravenous Magnesium Before Cisplatin

Case Report and Supporting Documentation: Acute Kidney Injury Manifested as Oliguria Is Reduced by Intravenous Magnesium Before Cisplatin

Preloading magnesium attenuates cisplatin-associated nephrotoxicity: pilot randomized controlled trial (PRAGMATIC study)

Preventive effect of 20 mEq and 8 mEq magnesium supplementation on cisplatin-induced nephrotoxicity: a propensity score–matched analysis

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