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Saline, mannitol, and furosemide hydration in acute cisplatin nephrotoxicity: a randomized trial

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Abstract

Objective

To determine which hydration (saline, saline + mannitol, or saline + furosemide) is associated with least cisplatin nephrotoxicity.

Methods

We randomized 49 women who received cisplatin (75 mg/m2 every 3 weeks) into one of the three hydration arms. The 24-h creatinine clearance was measured before and on day 6 after cisplatin infusion. The patients of each arm received 2 l of saline hydration. In the saline + furosemide arm, 40 mg of furosemide was given after hydration. In the saline + mannitol arm, 50 g of mannitol was mixed with the cisplatin.

Results

For the first cycle of chemotherapy, 15 women were randomized to saline, 17 to saline + furosemide, and 17 to saline + mannitol. For each group, the creatinine clearances before cisplatin infusion were (means±SD, milliliters per minute) 84.5±26.8, 82.5±24.0 and 87.4±25.6, and after cisplatin infusion were 79.1±31.9, 68.7±21.5, and 56.4±22.9, respectively. The decreases in creatinine clearance were similar between the saline group and the saline + furosemide group (P=0.66), but different between the saline + mannitol group and the saline group (P=0.02) or the saline + furosemide group (P=0.02). As each woman received multiple courses of cisplatin, 15 who received saline contributed 41 paired datasets, 17 who received saline + furosemide contributed 49 paired datasets, and 17 who received saline + mannitol contributed 36 paired datasets showed similar patterns.

Conclusions

Hydration with saline or saline + furosemide appears to be associated with less cisplatin nephrotoxicity than saline + mannitol.

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Acknowledgements

We wish to thank Robert Safirstein MD for his assistance in designing the study and James J. Grady DrPH for statistical assistance.

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Authors and Affiliations

  1. University of Tennessee Cancer Institute, 1331 Union Ave., Suite 800, Memphis, TN 38104, USA

    Joseph T. Santoso

  2. Clinical Science Building Room 316, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555, USA

    Joseph A. Lucci III, Ilona Schafer & Edward V. Hannigan

  3. Division of Gynecologic Oncology, Southwestern Medical Center, University of Texas, 5323 Harry Hines Blvd, Dallas, TX 75390, USA

    Robert L. Coleman

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  1. Joseph T. Santoso
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  2. Joseph A. Lucci III
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  3. Robert L. Coleman
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  4. Ilona Schafer
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  5. Edward V. Hannigan
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Correspondence to Joseph T. Santoso.

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Santoso, J.T., Lucci, J.A., Coleman, R.L. et al. Saline, mannitol, and furosemide hydration in acute cisplatin nephrotoxicity: a randomized trial. Cancer Chemother Pharmacol 52, 13–18 (2003). https://doi.org/10.1007/s00280-003-0620-1

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  • DOI: https://doi.org/10.1007/s00280-003-0620-1

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