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Poster display

1433 - Mannitol dosing and cisplatin-induced acute nephrotoxicity


09 Oct 2016


Poster display


Patwant Dhillon


Annals of Oncology (2016) 27 (6): 497-521. 10.1093/annonc/mdw390


P. Dhillon, E. Amir, M. Lo, A. Kitchlu, P. Yip, C. Chan, S. Cochlin, E. Chen, R. Lee, P. Ng

Author affiliations

  • Pharmacy, Princess Margaret Hospital, M5G 2M9 - Toronto/CA


Abstract 1433


Nephrotoxicity is a dose-limiting adverse effect of cisplatin. Mannitol is an osmotic diuretic given routinely as part of cisplatin regimens to prevent nephrotoxicity. There are limited data on the ideal dose of mannitol. At our centre, 3 different doses are used: 12 g, 20 g, and 40 g /cycle for cisplatin doses of ≥ 50 mg/m2.


A case-control study was performed. Electronic records of 1462 sequential outpatients who received cisplatin at ≥ 50 mg/m2 /cycle from 2010 to 2014 were reviewed. Patients experiencing acute nephrotoxicity of any grade within 30 days of last cisplatin dose (as defined by the National Cancer Institute Common Terminology Criteria for Adverse Effects version 4) were matched to a minimum of 2 and maximum of 5 controls based on the following criteria: age +/- 5 years; baseline estimated glomerular filtration rate (eGFR) +/- 10 mL/min/1.73m2; cisplatin dose per cycle; and presence of diabetes. Conditional logistic regression was used to identify baseline predictors of cisplatin-induced acute nephrotoxicity.


Of the 1245 included patients, 237 had nephrotoxicity and 1008 were matched controls. Median baseline eGFR for cases and controls were 83 and 80 mL/min/1.73m2, respectively. 3.8% of cases experienced ≥ grade 3 nephrotoxicity. Univariable analysis showed that diabetes, baseline eGFR, and baseline magnesium level were significantly associated with nephrotoxicity, whereas mannitol dosing did not show any association (odds ratio [OR] 1.08, p = 0.29). In multivariable analysis, diabetes (OR 1.86, p = 0.004) retained statistical significance, but baseline eGFR (OR 1.01, p = 0.06) and baseline magnesium level (OR 0.25, p = 0.08) showed non-significant associations with nephrotoxicity. Age, diabetes, cisplatin dose per cycle, mannitol dose per cycle, baseline eGFR, and baseline magnesium level were not predictors for severity of nephrotoxicity.


Cisplatin-induced acute nephrotoxicity remains common despite preventive measures in patients with good baseline renal function. Diabetes is a predictor of nephrotoxicity, whereas mannitol dosing has no significant influence, suggesting that doses may be standardized across cisplatin regimens.

Clinical trial identification

Legal entity responsible for the study

University Health Network


University Health Network


All authors have declared no conflicts of interest.

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