Does Magnesium Prevent Cisplatin-Associated Kidney Damage?

TOPLINE:

Patients with cancer who received prophylactic intravenous (IV) magnesium before starting cisplatin had a lower risk for cisplatin-associated acute kidney injury (AKI) than those who did not receive IV magnesium.

METHODOLOGY:

• AKI is a frequent and serious complication of cisplatin chemotherapy and is associated with poor outcomes. Although preclinical studies have shown that prophylactic IV magnesium can reduce kidney damage, evidence in humans has been limited.
• Researchers analyzed 13,719 adult patients with cancer (median age, 59 years; 57% men) who received their first dose of IV cisplatin between 2006 and 2022. Overall, 28.4% received a median dose of 2 g IV magnesium on the day of cisplatin administration.
• The primary outcome was moderate to severe cisplatin-associated AKI — defined as a twofold or higher increase in the serum creatinine level from baseline or receipt of kidney replacement therapy within 14 days after cisplatin initiation — or death.
• Secondary outcomes included cisplatin-associated AKI or death occurring within 10, 14, or 21 days and major adverse kidney events within 90 days.

TAKEAWAY:

• The rate of AKI or death within 14 days was lower among patients who received IV magnesium than among those who did not (2.7% vs 5.3%). The risk for AKI was 20% lower in patients who received IV magnesium (adjusted odds ratio [OR], 0.80; 95% CI, 0.66-0.97).
• Among 104 patients who received IV magnesium and developed the composite outcome (AKI or death), 82.7% developed AKI only, 9.6% died without AKI, and 7.7% developed AKI and died.
• Among 520 patients who did not receive IV magnesium and developed the composite outcome, 88.5% developed AKI without death, 8.3% died without AKI, and 3.3% developed AKI and died within 14 days.
• Patients with estimated glomerular filtration rate ≥ 90 mL/min/1.73m² (OR, 0.67; 95% CI, 0.52-0.87) and those with baseline serum magnesium levels of 2.0-2.2 mg/dL (OR, 0.67; 95% CI, 0.52-0.87) benefited the most from IV magnesium. Subgroup analyses also revealed greater benefits in patients aged less than 65 years (OR, 0.62; 95% CI, 0.45-0.84) and in women (OR, 0.64; 95% CI, 0.50-0.82).

IN PRACTICE:

“The findings of this multicenter cohort study suggest that prophylactic administration of IV magnesium — a safe, inexpensive, and readily available intervention — was independently associated with a lower risk of cisplatin-associated AKI in patients with cancer initiating cisplatin chemotherapy,” the authors wrote. However, “randomized controlled trials are warranted to confirm these findings.”

SOURCE:

The study, led by Shruti Gupta, MD, MPH, Division of Renal Medicine, Department of Medicine, Brigham and Women’s Hospital in Boston, was published online in JAMA Oncology.

LIMITATIONS:

Study limitations included baseline differences between the groups and lack of data on home medications, including oral magnesium and diuretics. Outcomes from only the first cycle of cisplatin administration were assessed, and information about IV fluid administration could not be reliably captured.

DISCLOSURES:

The study was supported by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases of the US National Institutes of Health. Several authors reported receiving consulting fees or having other ties with various sources, outside the submitted work.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.