Modern device might safeguard most cancers sufferers from chemotherapy-induced kidney harm



Utilizing affected person information from six main U.S. most cancers facilities, Brigham researchers and collaborators developed a danger prediction mannequin for moderate-to-severe kidney harm after receiving the chemotherapy drug cisplatin within the largest, first generalizable research of its type.

Cisplatin is a extremely efficient chemotherapy that has been used to deal with most cancers for many years, however it could possibly trigger kidney harm that may probably result in the discontinuation of life-saving most cancers remedies. Investigators from Brigham and Girls’s Hospital (BWH), a founding member of the Mass Common Brigham healthcare system, with researchers from the Dana-Farber Most cancers Institute and different establishments, developed a complete device to foretell which sufferers are at highest danger of moderate-to-severe kidney harm after cisplatin. They discovered that the highest-risk sufferers had as a lot as a 20-fold increased danger of growing kidney harm after cisplatin than these within the lowest-risk group. Their outcomes are revealed in The BMJ.

“Sufferers receiving remedy for most cancers are more and more affected by kidney harm, which is related to increased mortality and might jeopardize eligibility for different therapies,” mentioned first writer Shruti Gupta, MD, MPH, director of Onco-nephrology at BWH and Dana-Farber and a doctor in BWH’s Division of Renal Medication. 

Cisplatin is a well known kidney toxin, and though there are newer remedies out there, it stays a cornerstone of remedy for sufferers with most cancers globally. This huge, multicenter collaboration and ensuing danger prediction mannequin is a vital step within the care of sufferers who’re getting cisplatin.”

Shruti Gupta, MD, MPH, Director of Onco-nephrology, BWH

The researchers examined information from over 24,000 sufferers throughout six main U.S. most cancers facilities, together with Dana-Farber Brigham Most cancers Heart, Mass Common Most cancers Heart, Memorial Sloan Kettering Most cancers Heart, MD Anderson Most cancers Heart, College of Colorado, and Northwell Well being, and analyzed the danger of moderate-to-severe acute kidney harm inside the first 14 days following a single, first IV dose of cisplatin. The mannequin developed by the analysis crew included a number of necessary danger components for kidney harm together with age, hypertension, diabetes, laboratory findings from routinely out there bloodwork, and better doses of cisplatin. They discovered that sufferers who developed kidney harm from cisplatin had a significantly increased danger of dying in comparison with those that didn’t.

One other key discovering was that decrease ranges of magnesium had been an necessary danger issue for acute kidney harm. The researchers plan to make use of the identical wealthy database to attempt to establish therapies which may forestall kidney harm, together with magnesium.

Utilizing the danger rating, the analysis crew created a easy on-line calculator that will likely be made out there to be used at MDCalc.com. A affected person or doctor can use this calculator to quantify the danger of kidney harm by inputting info, together with whether or not the affected person has hypertension, diabetes, or different ailments or medical circumstances, together with outcomes from their bloodwork.

“This new device can assist an oncologist and a affected person have extra knowledgeable conversations in regards to the dangers and advantages of cisplatin. If a affected person is at excessive danger, their medical crew can contemplate preventative measures similar to administering extra IV fluids earlier than receiving cisplatin or monitoring their kidney perform extra intently afterward,” mentioned senior writer David E. Leaf, MD, MMSc, director of medical and translational analysis in acute kidney harm at BWH’s Division of Renal Medication. “The medical traits and lab values which might be integrated in our mannequin are available and simply obtainable from medical information, so our hope is that this device will be applied anyplace cisplatin is given.”

Supply:

Journal reference:

Gupta, S., et al. (2024). Derivation and exterior validation of a easy danger rating for predicting extreme acute kidney harm after intravenous cisplatin: cohort research. BMJ. doi.org/10.1136/bmj-2023-077169.

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