Conventional cytotoxic chemotherapy-associated nephrotoxicity: consensus report of the 34th Acute Disease Quality Initiative (ADQI) Workgroup.

Abstract

The subfield of onconephrology has rapidly grown with the proliferation of highly effective cancer therapies and the remarkable improvement in patient survival. Conventional cytotoxic chemotherapy is the backbone of cancer therapy, often used alone or with targeted agents and immunotherapies. However, beneficial anticancer effects are often complicated by nephrotoxicity, which includes acute and chronic kidney injury. Although numerous conventional cytotoxic chemotherapy drugs are nephrotoxic, some of the most common offenders that clinicians encounter are cisplatin, ifosfamide, methotrexate, pemetrexed, gemcitabine, melphalan, and mitomycin C. They will be the focus of this review. This Acute Disease Quality Initiative Consensus Conference Workgroup covered cytotoxic chemotherapy nephrotoxicity and reviewed several aspects of their adverse kidney complications. Included are (i) epidemiology of each agent's nephrotoxicity, (ii) mechanisms of nephrotoxicity, (iii) predisposing risk factors, (iv) clinical manifestations of nephrotoxicity, (v) prevention and management of kidney injury, and (vi) research agenda addressing knowledge gaps for the noted nephrotoxic cytotoxic chemotherapy.