Mannitol reduces cisplatin-induced nephrotoxicity in patients with cancer
Mannitol administration lowers the incidence and severity of nephrotoxicity in patients treated with cisplatin, a recent study suggests.
Researchers performed a quasi-experimental retrospective analysis, approved by the Institutional Review Board of inpatient and outpatient adults receiving cisplatin doses ≥40 mg/m2, to investigate the effect of mannitol on renal function and describe the incidence of cisplatin-induced nephrotoxicity.
There were 313 patients (95 treated with mannitol and 218 without) included in the analysis. The mean change in serum creatinine from baseline was the primary outcome, and incidences of various grades of nephrotoxicity were the secondary outcomes.
Patients who received mannitol had lower average increase in serum creatinine compared with those who did not (0.30 vs 0.47 mg/dL; 95 percent CI, 0.03 to 0.31 for difference; p=0.02). Mannitol-receiving patients also had fewer occurrences of ≥grade 2 nephrotoxicity compared with those who did not (8 vs 17 percent; p=0.04).
Furthermore, nongynaecologic regimens (6 vs 23 percent; p=0.001) and those who received doses ≥70 mg/m2 of cisplatin (7 vs 22 percent; p=0.03) had reduced rates of ≥grade 2 nephrotoxicity with mannitol.
“The results of the study suggest mannitol may be most effective when used with nongynaecologic regimens and with cisplatin doses ≥70 mg/m2,” researchers said.
“Cisplatin-induced nephrotoxicity is a dose limiting adverse effect that occurs in nearly one-third of patients. Mannitol administration has been used as a means to negate this toxicity,” they added.
In another study, researchers found that the addition of mannitol to saline hydration lowered the incidence of grade 3 increases in serum creatinine in patients with squamous cell cancer of the head and neck. Hyponatremia was also likely to occur in the mannitol group. [Support Care Cancer 2016;24:1789-93]