The Role of Mannitol as a Nephroprotectant in Patients Receiving Cisplatin Therapy

Objective: To review the efficacy and safety of concomitant mannitol administration with cisplatin therapy to reduce the incidence of nephrotoxicity. Data Sources: A literature search was performed via MEDLINE, PubMed, and the Cochrane Library (1945-August 2011) using the terms mannitol, cisplatin, nephrotoxicity, and forced diuresis. Reference citations from the publications identified were also reviewed. Study Selection and Data Extraction: The search was limited to studies conducted in humans. All studies in which mannitol was used for forced diuresis with cisplatin therapy were evaluated. Data Synthesis: Cisplatin therapy can lead to transient and permanent renal impairment. Molecular and histologic changes occur in the renal tubules, which contribute to nephrotoxicity. The adverse effect profile of cisplatin is well documented, but the prevention strategies to alleviate renal impairment due to treatment are less understood. Mannitol plus hydration has been used for several years to alleviate toxicity associated with cisplatin therapy. However, the data for mannitol administration have not been convincing. When the use of mannitol and hydration is compared directly to hydration alone, mannitol shows no benefit. In some patients, not only was mannitol not protective, its administration was associated with worsening renal function. Conclusions: Although mannitol plus hydration is used to decrease cisplatin-induced nephrotoxicity, there are no compelling data that the addition of mannitol is more nephroprotective than the use of hydration alone. Appropriate hydration remains the most reasonable strategy to reduce the incidence of cisplatin-induced nephrotoxicity.

[1]  C. Bokemeyer,et al.  Platinum organ toxicity and possible prevention in patients with testicular cancer , 1999, International journal of cancer.

[2]  Z. Dong,et al.  Cisplatin nephrotoxicity: mechanisms and renoprotective strategies. , 2008, Kidney international.

[3]  W. Kramer,et al.  Renal excretion kinetics of high-dose cis-dichlorodiammineplatinum(II) administered with hydration and mannitol diuresis. , 1979, Cancer treatment reports.

[4]  R. Lange,et al.  Clinical and pharmacological studies with cis-diamminedichloroplatinum (II). , 1973, Cancer research.

[5]  M. Ro̸rth,et al.  Acute and long-term nephrotoxicity of cis-platinum in man , 2004, Cancer Chemotherapy and Pharmacology.

[6]  J. Holland,et al.  Diaminodichloroplatinum: A phase I study showing responses in testicular and other tumors , 1974, Cancer.

[7]  S. Sternberg,et al.  The renal pathology in clinical trials of Cis‐platinum (II) diamminedichloride , 1977, Cancer.

[8]  K. Shu,et al.  Mannitol-induced acute renal failure. , 2010, Clinical nephrology.

[9]  L. Balducci,et al.  Cisplatin hydration with and without mannitol diuresis in refractory disseminated malignant melanoma: a southwest oncology group study. , 1982, Cancer treatment reports.

[10]  K. Nugent,et al.  Cisplatin Nephrotoxicity: A Review , 2007, The American journal of the medical sciences.

[11]  R. Golbey,et al.  High dose Cis‐platinum diammine dichloride. Amelioration of renal toxicity by mannitol diuresis , 1977, Cancer.

[12]  S. Legha,et al.  High-dose cisplatin administration without hypertonic saline: observation of disabling neurotoxicity. , 1985, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[13]  N. Bachur,et al.  High-dose cisplatin therapy using mannitol versus furosemide diuresis: comparative pharmacokinetics and toxicity. , 1981, Cancer treatment reports.

[14]  J. Sondheimer,et al.  Mannitol‐Induced Acute Renal Failure , 1990, Medicine.

[15]  R. Coleman,et al.  Saline, mannitol, and furosemide hydration in acute cisplatin nephrotoxicity: a randomized trial , 2003, Cancer Chemotherapy and Pharmacology.

[16]  D. Baribeault,et al.  A comparison of the rates of cisplatin (cDDP) - induced nephrotoxicity associated with sodium loading or sodium loading with forced diuresis as a preventative measure , 2010, Journal of oncology pharmacy practice : official publication of the International Society of Oncology Pharmacy Practitioners.

[17]  N. Holstein-Rathlou,et al.  Renal tubular function in patients treated with high‐dose cisplatin , 1988, Clinical pharmacology and therapeutics.

[18]  E. Henderson,et al.  Phase I study of high-dose cis-dichlorodiammineplatinum(II) with forced diuresis. , 1977, Cancer treatment reports.