Lower blood pressure and risk of cisplatin nephrotoxicity: a retrospective cohort study

Abstract

BackgroundThe pathophysiological mechanisms of cisplatin nephrotoxicity include the reduction of renal blood flow, as well as tubular epithelial cell toxicity. The objective of this study was to investigate the influence of lower blood pressure and decreased food intake on the incidence of cisplatin nephrotoxicity.MethodsWe conducted a retrospective cohort study at a university hospital between 2011 and 2012. We identified hospitalized adult patients with head and neck cancer, esophageal cancer, or gastric cancer, who received intravenous cisplatin administration. The primary outcome was the incidence of cisplatin nephrotoxicity defined as the increase in serum creatinine after cisplatin administration more than 1.5 times from baseline.ResultsThe study participants included 182 patients, in whom we observed a total of 442 cycles of cisplatin chemotherapy. The incidence of cisplatin nephrotoxicity was observed in 41 of 182 cycles with initial administration. Multivariate logistic regression analysis showed that systolic blood pressure was independently associated with cisplatin nephrotoxicity (adjusted odds ratio 0.75, 95% confidence interval 0.57 to 0.95 for each 10 mmHg). The use of renin-angiotensin system (RAS) inhibitors was also associated with cisplatin nephrotoxicity (3.39, 1.30 to 8.93). Among quartiles of systolic blood pressure in all cycles of chemotherapy, the incidence of nephrotoxicity in the lower blood pressure group was significantly higher than that in the higher blood pressure group for patients taking non-solid food (P = 0.037), while there was no significant difference for patients taking solid food (P = 0.67).ConclusionsLower blood pressure and the use of RAS inhibitors were associated with the incidence of cisplatin nephrotoxicity, and lower blood pressure had a greater influence on nephrotoxicity in patients who could not take solid food. Discontinuation of antihypertensive medication including RAS inhibitors before cisplatin chemotherapy should be considered, which may be beneficial for patients with lower blood pressure.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-017-3135-6) contains supplementary material, which is available to authorized users.

The characteristics and risk factors for cisplatin-induced acute kidney injury in the elderly

“…23 ACEI/ARBs may suppress the activity of the renin-angiotensin system that maintains the GFR, aggravating kidney ischemia and delaying cisplatin excretion. 24 Recently, a clinical study also found that ACEI use was associated with renal toxicity during platinum-based chemoradiation. 25 Therefore, the discontinuation of ACEI/ARBs use should be suggested when patients undergo chemotherapy with cisplatin.…”

Renal Toxicity From Pemetrexed and Pembrolizumab in the Era of Combination Therapy in Patients With Metastatic Nonsquamous Cell NSCLC

“…Besides NSAIDs, interruption of the use of diuretics, angiotensinconverting enzyme inhibitors, or angiotensin II receptor blockers should be considered, as different studies have revealed an association between nephrotoxicity and the use of these agents during platinum chemotherapy. 38,39 Among patients treated with ICI, 60% were taking drugs known to potentially cause ATIN 40 ; thus, discontinuation of these drugs should be considered.…”

Losartan risk for female in cisplatin-induced nephrotoxicity

“…Komaki et al . [1] in their cohort study concluded that “Lower blood pressure and the use of renin-angiotensin system inhibitors were associated with the incidence of cisplatin nephrotoxicity” while Liu et al . [2] in their study mentioned that “Angiotensin-converting enzyme inhibitor/angiotensin receptor blocker usage and administration of a single application of cisplatin were independent risk factors for cisplatin-induced acute kidney injury in the elderly.”…”

“…In other nephrotoxic agents such as contrast, angiotensin receptor blockers have been known as an agent that increase nephrotoxicity, and in these situations, discontinuation of angiotensin receptor blockers 24–48 h before contrast administration is recommended. [16] As a conclusion, it seems that in the condition of losartan and cisplatin treatments simultaneously, females are more at risk.…”