medwireNews: Prophylactic treatment with intravenous (IV) magnesium could reduce the risk for cisplatin-related acute kidney injury (CP-AKI) among patients with cancer initiating treatment with the chemotherapeutic agent, indicate findings from a multicenter cohort study.
The risk was a significant 20% lower for patients who did versus did not receive IV magnesium, report Shruti Gupta (Brigham and Women’s Hospital, Boston, Massachusetts, USA) and team in JAMA Oncology.
Noting that IV magnesium is “a safe, inexpensive, and readily available intervention,” they say that these results “warrant confirmation in randomized clinical trials.”
Outlining the rationale for the study, the authors explain that although prophylactic administration of IV magnesium has been shown to attenuate CP-AKI in animal models, “its association with CP-AKI in humans has not been rigorously evaluated.”
They therefore analyzed data for 13,719 participants of a large cohort comprising adults treated with a first dose of cisplatin between 2006 and 2022 at one of five US cancer centers, the majority of whom were men (57.0%) and White (76.6%).
A total of 3893 patients (28.4%) received IV magnesium, at a median dose of 2 g, on the day of cisplatin initiation, while the remaining 9826 patients (72.6%) did not.
The primary outcome was a composite of moderate-to-severe CP-AKI or death, where CP-AKI was defined as a twofold or greater increase in serum creatinine levels from baseline or receipt of kidney replacement therapy within 14 days of starting cisplatin, and this occurred in 2.7% of individuals who received IV magnesium and 5.3% of those who did not.
Using inverse probability of treatment weighting to adjust for confounding, Gupta and colleagues found that receipt of IV magnesium was associated with a significantly lower risk for the composite outcome, at an adjusted odds ratio (OR) of 0.80.
They report that the findings “were consistent across sensitivity analyses,” including when multivariable logistic regression was used to adjust for confounding, the magnesium exposure window was expanded to include the 3 days prior to cisplatin initiation, and the analysis was restricted to those who received 2 mg or more of magnesium, with significant ORs of 0.71, 0.79, and 0.71, respectively.
Moreover, the “results were similar or greater in magnitude across nearly all secondary outcomes, including CP-AKI defined more liberally and more strictly,” adds the team.
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