Kidney Week

Abstract: FR-OR78

Effect of Intravenous Magnesium on Cisplatin-Associated AKI

Session Information

• Onconephrology: Models, Markers, and Medications
  October 25, 2024 | Location: Room 33, Convention Center
  Abstract Time: 05:20 PM - 05:30 PM

Category: Onconephrology

• 1700 Onconephrology

Authors

• Gupta, Shruti, Brigham and Women's Hospital, Boston, Massachusetts, United States

Shruti Gupta, MD, MPH

• Glezerman, Ilya, Memorial Sloan Kettering Cancer Center, New York, New York, United States

Ilya Glezerman, MD

• Hirsch, Jamie S., Northwell Health, New Hyde Park, New York, United States

Jamie S. Hirsch, MD

• Wells, Sophia L., Brigham and Women's Hospital, Boston, Massachusetts, United States

Sophia L. Wells

• Ortega, Jessica L., Brigham and Women's Hospital, Boston, Massachusetts, United States

Jessica L. Ortega

• Bansal, Anip, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States

Anip Bansal, MD, FASN

• Joy, Melanie S., University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States

Melanie S. Joy, PharmD, PhD, FASN

• Abudayyeh, Ala, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States

Ala Abudayyeh, MD, FASN

• Leaf, David E., Brigham and Women's Hospital, Boston, Massachusetts, United States

David E. Leaf, MD, MS, MSc, FASN

Background

In animal models, prophylactic administration of IV magnesium (Mg) attenuates cisplatin-associated acute kidney injury (CP-AKI), whereas Mg deficiency increases susceptibility to CP-AKI. These findings may be due to the direct effect of Mg on the expression of cisplatin transporters in the proximal tubules. We examined the association between IV Mg administration and risk of CP-AKI in a large cohort.

Methods

We emulated a hypothetical randomized clinical trial (RCT) in which patients receiving cisplatin did or did not receive IV Mg on the day of cisplatin administration. We used data from a multicenter cohort study of adults treated with their first dose of IV cisplatin between 2006-2022 at five major cancer centers across the US. The primary outcome was moderate-to-severe CP-AKI, defined as a ≥2-fold rise in rise in serum creatinine or receipt of dialysis within 14 days following IV cisplatin. We used multivariable logistic regression to adjust for confounders, including age, race, sex, comorbidities, baseline laboratory values, exposure to other nephrotoxic chemotherapy, and cisplatin dose.

Results

Of the 13,719 patients included in the study, 92 of 3893 patients (2.4%) who received IV Mg and 477 of the 9826 (4.9%) who did not receive IV Mg, developed CP-AKI. The adjusted odds ratio for development of CP-AKI among those who did vs. did not receive IV Mg was 0.73 (95% CI, 0.57-0.92). Findings were consistent across a number of sensitivity and subgroup analyses (Figure). The protective effect of IV Mg on CP-AKI was consistent across different cisplatin doses, though there was a trend toward greater benefit in patients receiving lower doses of cisplatin.

Conclusion

Administration of IV Mg may be associated with a lower risk of CP-AKI. These findings should be confirmed in a RCT.

Funding

• NIDDK Support