Mannitol for the prevention of cisplatin-induced nephrotoxicity: a prospective comparison of hydration plus mannitol versus hydration alone in the military hospital in tunisia.

Background: Cisplatin isa very effective drug for the treatment of several malignancies, and their use has contributed to an increase in the long-term survival of patients with cancer. Unfortunately, the risk of nephrotoxicity is a dose limiting adverse effect that occurs in nearly one-third of patients receiving cisplatin-based chemotherapy.
The study aim was to evaluate the incidence of cisplatin-induced nephrotoxicity in patients treated with and without mannitol. Material and methods: A comparative prospective study enrolling patients treated with cisplatin. All patients received 1000 ml of normal saline (0.9%) infused over 1 hour prior to Cisplatin administration, and 2000 mL infused over 3 hours after Cisplatin administration. The Mannitol group received 250 mL of Mannitol 10% concomitant with Cisplatin, infused over 1 hour if the dose of cisplat in is inferior to 70mg/m2 orover 3 hours if the dose of Cisplatin is superior to 70mg/m2. The primary outcome was mean change in serum creatinine from baseline .Secondary outcomes included incidence of acute nephrotoxicity. The difference in the incidence of nephrotoxicity was compared using the Fischer’s exact test and the change in serum creatinine was compared using the Student’s t-test (P<0.05).
Results: 35 patients (17with Mannitol and 18 without) were evaluated.The average increase in serum creatinine (mg/dL) was 0.107 in patients who received Mannitol while 0.114 in those who received hydration alone (p= 0.67). In the group which received mannitol, 7.4% experienced nephrotoxicity while 21.7% in the hydration alone group experienced nephrotoxicity (p=0.47). Patients who received doses >=70mg/m2 of cisplatin had a slightly lower rates of nephrotoxicity with mannitol.
Conclusion: These results demonstrate that the new hydration protocol comprising Mannitol10% specially when the dose is superior to 70mg/m² could prevent the nephrotoxicity induced by cisplatin without affecting the treatment outcome