Impact of Different Diuretic Protocols on the Prevention of Renal Impairment and Extravasation Incidences During Short Hydration in Cisplatin Administration

Abstract

The short hydration method using magnesium and diuretics has been widely adopted to prevent cisplatin-induced nephrotoxicity. Both mannitol and furosemide are commonly used as diuretics in this approach, but there is no clear consensus on the benefits or risks of combining the two. Mannitol is associated with a higher risk of vascular problems, such as extravascular leakage and vasculitis, owing to its high osmolality. In this study, we investigated the risk of vascular problems and cisplatin-induced nephrotoxicity in patients who underwent short hydration with both mannitol and furosemide and in those who underwent short hydration with furosemide alone during the administration of cisplatin. Propensity score matching was performed to control for background characteristics, and logistic regression analysis was conducted to identify risk factors. The use of both mannitol and furosemide was significantly associated with a higher risk of extravasation (odds ratio [OR] = 8.29) and vascular events (OR = 12.58) compared with the use of furosemide alone. In contrast, the degree of renal function decline and incidence of grade ≥ 2 nephrotoxicity did not significantly differ between the groups. These findings suggest that adding mannitol to furosemide does not provide an additional benefit in preventing cisplatin-induced nephrotoxicity but may increase the risk of vascular adverse events. Therefore, as a general rule, furosemide alone is recommended as the diuretic in the short hydration method to prevent cisplatin-induced nephrotoxicity as well as extravascular leakage and vasculitis.