Retrospectively defining the risk of developing contrast nephropathy in patients receiving cisplatin treatment

Objective: Contrast-induced nephropathy (CIN) is a complication characterized by deterioration of renal function within 48 to 72 hours following intravascular iodinated contrast media administration. after exclusion of all other potential causes of acute renal failure. CIN is commonly defined as a 1.5-fold increase in baseline serum creatinine level. or an increase of 0.3 mg/dL or more after contrast media exposure. Cisplatin is a platinum-based chemotherapy drug used as first-line treatment for many malignancies. However. its clinical use is limited due to its cumulative and dose-related side effects. especially nephrotoxicity. A history of renal dysfunction is the most common risk factor for CIN and cisplatin-induced nephrotoxicity. Currently. the main precautions to prevent the development of both CIN and cisplatin-induced nephrotoxicity are minimal use and adequate hydration. In our study. we aimed to evaluate the effects of cisplatin treatment on contrast nephropathy. potential risk factors in patients who developed contrast nephropathy and whether acute kidney injury is reversible in the long term period. Material and Methods: This study was performed with the Institutional Review Board protocol approval date 23/05/2023 and number 2023.110.IRB1.034 in Koc Unıversity Faculty of Medicine. Department of Medical Oncology between 01.01.2020 – 01.01.2023. A total number of 200 patients. aged between 18-65 years. with contrast media exposure were prospectively included in present study. The study group consisted of 100 patients diagnosed with various malignancies and treated with cisplatin. while the control group included 100 patients with only contrast media exposure. According to the diagnostic criteria of KDIGO guidelines. acute kidney injury was defined as an increase in baseline serum creatinine of 0.3 mg/dL on the third day after exposure. Additionally. demographic data (age. gender). detailed anamnesis. medications used. physical examination findings. and laboratory findings at baseline. day 3 and month 1 after contrast agent exposure were recorded and evaluated between the groups. Results: In present study. the overall prevalence of AKI was 7.4% (n=15). 8.8% in the cisplatin group and 6.6% in the control group. A statistically higher prevalence of AKI was observed in patients older than 75 years in the platinum group (7% vs. 25%) and in patients older than 65 years in the control group (<65 years 2% vs. ≥65 years 11%). Moreover. according to logistic-regression analysis in the cisplatin group. the risk of developing AKI was found to be approximately 4.6 times higher (p=0.05) in the univariate analysis and 6.3 times higher (p=0.039) in the multivariate analysis in patients aged 75 years and older. Additionally. baseline BMI. magnesium and potassium medyan values were significantly lower in the platinum group compared to the control group. In our study. low BMI (<18.5) was associated with a 0.21-fold increase in the risk of acute kidney injury in univariate analysis (p=0.05). Similarly. low levels of magnesium below 1.6 mmol/L were significantly (p=0.01 and p=0.013. respectively) increased the risk of acute kidney injury in both univariate (OR 0.16 - 95%CI) and multivariate (OR 0.13 - 95%CI) analyses. Conclusions: Our study clearly demonstrated that contrast agent exposure is an independent risk factor for acute kidney injury in elderly patients receiving cisplatin therapy. In addition. electrolyte imbalances represented by baseline hypercalcemia. hypomagnesemia. hypokalemia and low BMI values in the platinum group were found to predispose to acute kidney injury. Therefore. it is obvious that detailed anamnesis. risk analysis. and the application of adequate prevention strategies. including the use of the lowest possible doses and the number of contrast media applications. will significantly reduce the side effects of chemotherapy in patients already burdened with cancer. In this respect. comparison of the present findings with further data from larger study groups may contribute to diagnosis. prevention and management of AKI induced by cisplatin and contrast media. Key Words: Contrast media-induced nephropathy (CIN); Cisplatin; Cisplatin Induced Nephrotoxicity; Acute Kidney Injury (AKI); Risk Factors.