Prevention of Cisplatin-Induced Acute Kidney Injury: A Systematic Review and Meta-Analysis
Cisplatin-induced acute kidney injury (CIA) is a serious adverse event that affects 20–40% of exposed patients, despite any implemented precaution to avoid it. The aim of this work was therefore to identify a relevant nephroprotective method for CIA.
We searched Pubmed, Embase, and Web of Science from 1 January 1978 to 1 June 2018, without language restriction. All studies (observational and interventional) assessing a CIA prevention method for adults receiving at least one course of cisplatin were eligible. The primary outcome was acute nephrotoxicity, as defined by the AKI-KDIGO classification (2012). The odds ratio and corresponding 95% confidence interval were used to assess the associations. We used narrative synthesis in case of heterogeneity regarding intervention, population, or outcome. When possible, a random-effects model was used to pool studies. The heterogeneity between studies was quantified (I2), and multiple meta-regressions were carried out to identify potential confounders.
Within 4520 eligible studies, 51 articles fulfilling the selection criteria were included in the review, assessing 21 different prevention methods. A meta-analysis could only be performed on the 15 observational studies concerning magnesium supplementation (1841 patients), and showed a significant nephroprotective effect for all combined grades of CIA (OR 0.24, [0.19–0.32], I2 = 0.0%). This significant nephroprotective effect was also observed for grades 2 and 3 CIA (OR 0.22, [0.14–0.33], I2 = 0.0% and OR 0.25, [0.08–0.76], I2 = 0.0%, respectively).
While no method of prevention had so far demonstrated its indisputable efficacy, our results highlight the potential protective effect of magnesium supplementation on cisplatin-induced acute nephrotoxicity.
This study is registered in PROSPERO, CRD42018090612.
The authors thank Prof. Sylvester who sent us the raw data of his study and allowed us to integrate it in our work.
Conceptualization: AH, RL, MM, JJB, FG. Supervision: AH, RL, MM, JJB, FG. Search strategy: AH, RL. Studies selection: AH, RL. Data curation: AH, RL, MM. Data synthesis and analysis: JJB. Data interpretation: AH, RL, MM, JJB, FG. Manuscript writing: AH, MM. Validation: AH, RL, MM, JJB, ES, PC, LB, NP, CC, ED, FG, MH, AS, and XD. Review and editing: ES, PC, LB, NP, CC, ED, FG, MH, AS, and XD (editing by an English native speaker: PC). Approved the final version of the manuscript: all the authors.
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no conflicts of interest related to the content of this article (AH, RL, MM, JJB, ES, PC, LB, NP, CC, ED, FG, MH, AS, and XD).
This review received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
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