Q&A: Researchers discuss how IV magnesium reduces kidney damage from cisplatin chemotherapy

Shruti Gupta, MD, MPH, and David Leaf, MD, MMSc, of the Renal Division, Department of Medicine at Brigham and Women’s Hospital are the first and senior authors, respectively, of a paper published in JAMA Oncology, “Intravenous Magnesium and Cisplatin-Associated Acute Kidney Injury: A Multicenter Cohort Study.”

In this interview, they discuss their research.

How would you summarize your study?

Cisplatin is a chemotherapy drug used globally for the treatment of several cancers; however, it is also highly toxic to the kidneys. Beyond general supportive measures, there is minimal data from clinical trials regarding preventive treatments for cisplatin-associated kidney damage.

Animal studies suggest magnesium may help the kidneys excrete cisplatin in the urine, thereby protecting the kidneys from damage. However, data from larger studies in humans is lacking.

What question were you investigating?

We examined whether receipt of IV magnesium on the same day as the first dose of IV cisplatin was associated with a reduced risk of cisplatin-associated kidney damage.

What approach did you use?

We collected data on 13,719 patients receiving their first dose of cisplatin between 2006–2022 across five major cancer centers in the U.S. Around 30% of them received IV magnesium. We then tested whether magnesium receipt was associated with a lower risk of cisplatin-associated kidney injury, ensuring we accounted for a detailed list of key potential confounding variables.

What did you find?

Patients who received IV magnesium had a 20% lower adjusted odds of developing kidney damage from cisplatin compared to those who did not receive IV magnesium. Our findings suggest that IV magnesium administration may reduce the incidence of cisplatin-associated kidney damage. These findings were similar across a number of subgroup and sensitivity analyses.

What are the implications and next steps?

Our findings suggest that patients may benefit from receiving IV magnesium prior to receiving IV cisplatin. Magnesium is cheap, safe, and readily available around the world. Further, its use in the context of prevention of cisplatin-associated kidney injury is well-supported by animal models. Nevertheless, our findings warrant confirmation in a randomized clinical trial. There is currently one underway at Brigham and Women’s Hospital.