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Background <p>Intravenous magnesium supplementation is increasingly adopted as a nephroprotective measure in patients receiving cisplatin-based chemotherapy, particularly in several Asian and European oncology centers. However, the dose-dependent nature of this effect remains poorly defined, and most studies have not addressed long-term renal outcomes.</p> Methods <p>In this multicenter retrospective study, 287 patients undergoing weekly cisplatin-based chemoradiotherapy for head and neck or cervical cancer were stratified based on prophylactic magnesium dose: 12&#xa0;mEq or 24&#xa0;mEq IV magnesium sulfate. Serum creatinine (sCr) and estimated glomerular filtration rate (eGFR) were measured at baseline, during treatment, and up to 12&#xa0;months post-treatment. The incidence of acute kidney injury (AKI) was defined using CTCAE v5.0 criteria. Comparative analysis was performed using standard statistical tests, and results were contextualized with recent large-scale cohort findings.</p> Results <p>AKI incidence was 17.7% in the 12&#xa0;mEq group and 13.2% in the 24&#xa0;mEq group (<i>p</i> = 0.32). However, longitudinal renal follow-up revealed a significant divergence in sCr and eGFR trajectories: the 24&#xa0;mEq cohort maintained near-baseline renal function, whereas the 12&#xa0;mEq group exhibited progressive deterioration at 6 and 12&#xa0;months. These findings contrast with prior binary exposure studies and indicate a sustained, dose-dependent protective effect.</p> Conclusions <p>Magnesium’s renoprotective benefit in cisplatin-based therapy is not only determined by its presence, but also by its dose. Our results support the incorporation of standardized magnesium dosing, specifically a minimum of 24&#xa0;mEq, into clinical protocols. Dose precision, not merely inclusion, should guide prophylactic strategies to ensure effective renal protection.</p>

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Dose matters: a dose-stratified real-world analysis of magnesium sulfate in preventing cisplatin-induced nephrotoxicity

  • 期刊论文

  • 发表日期：

    2026年3月7日

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  • Arif Hakan Önder,
  • Yusuf İlhan,
  • Mehmet Mutlu Çatlı

摘要

Background

Intravenous magnesium supplementation is increasingly adopted as a nephroprotective measure in patients receiving cisplatin-based chemotherapy, particularly in several Asian and European oncology centers. However, the dose-dependent nature of this effect remains poorly defined, and most studies have not addressed long-term renal outcomes.

Methods

In this multicenter retrospective study, 287 patients undergoing weekly cisplatin-based chemoradiotherapy for head and neck or cervical cancer were stratified based on prophylactic magnesium dose: 12 mEq or 24 mEq IV magnesium sulfate. Serum creatinine (sCr) and estimated glomerular filtration rate (eGFR) were measured at baseline, during treatment, and up to 12 months post-treatment. The incidence of acute kidney injury (AKI) was defined using CTCAE v5.0 criteria. Comparative analysis was performed using standard statistical tests, and results were contextualized with recent large-scale cohort findings.

Results

AKI incidence was 17.7% in the 12 mEq group and 13.2% in the 24 mEq group (p = 0.32). However, longitudinal renal follow-up revealed a significant divergence in sCr and eGFR trajectories: the 24 mEq cohort maintained near-baseline renal function, whereas the 12 mEq group exhibited progressive deterioration at 6 and 12 months. These findings contrast with prior binary exposure studies and indicate a sustained, dose-dependent protective effect.

Conclusions

Magnesium’s renoprotective benefit in cisplatin-based therapy is not only determined by its presence, but also by its dose. Our results support the incorporation of standardized magnesium dosing, specifically a minimum of 24 mEq, into clinical protocols. Dose precision, not merely inclusion, should guide prophylactic strategies to ensure effective renal protection.