Document Type: Letter to Editor


1 Associate Professor, Department of internal medicine, Tehran University of medical sciences, Tehran, Iran

2 Assistant Professor, Chronic Renal Failure Research Center, Jundishapour University of Medical Sciences, Ahvaz, Iran

3 Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

Dear editor

With great interest, we have recently read the published article by Beladi Mousavi et al. entitled “The protective effect of hydration with Isotonic Saline, KCl and MgSo4 on Cisplatin nephrotoxicity” in your most valuable journal (1).

The author evaluated the possible effect of hydration with isotonic saline, KCl and MgSo4 on prevention of cisplatin nephrotoxicity among patientswith various malignancies who received cisplatinat a dosage of at least 50 mg/m2 combined with other chemotherapy agents. According to the results of the study, the prevalence of cisplatin-induced renal impairment has decreased and hydration with isotonic saline has a protective effect against cisplatin nephrotoxicity (1).

Cisplatin is a potent antineoplastic agent which is currently used in the treatment of broad spectrum of malignancies. However, the use of cisplatin is limited because of cisplatin nephrotoxicity which can be progressive in a significant percent of patients (2,3).

The most important clinical manifestation of cisplatin nephrotoxicity is acute and chronic renal impairment which can be associated with significant morbidity and mortality among these patients (4-10).

Hypomagnesaemia, hypokalemia, salt wasting, Falconry syndrome and thrombotic microangiopathy with features of the hemolytic-uremic syndrome or thrombotic thrombocytopenic purpura are other manifestations of cisplatin nephrotoxicity which have also occurred in a significant percent of cases (11).

Therefore, measures for prevention of cisplatin-induced renal impairment must be used in all of the patients who are candidates for cisplatin administration (11,12).

The results of Beladi Mousavi et al. are interesting. According to the results of the study, the prevalence of acute renal failure resulting from this drug among patients, who were well hydrated with isotonic saline before and after the cisplatin injection, is 6.6 percent which is significantly less than the reported prevalence of cisplatin nephrotoxicity among the patients who are not hydrated (1). However, the results of the study are limited due to short duration and small number of patients enrolled in the study. In addition, the study didn’t have a control group and; therefore, in order to gain a better evaluation of preventive effect of isotonic saline, a multicenter clinical trial with long duration, large number of patients and control groups is required.

1.       Beladi Mousavi SS, Hossainzadeh M, Khanzadeh A, Hayati F, Beladi Mousavi M, Zeraati AA, et al. Protective Effect of Forced Hydration with Isotonic Saline, Potassium Chloride and Magnesium Sulfate on Cisplatin Nephrotoxicity: An Initial Evaluation. Asia Pac J Med Toxicol 2013;2:136-9.

2. Yao X, Panichpisal K, Kurtzman N, Nugent K. Cisplatin nephrotoxicity: a review. Am J Med Sci 2007;334:115–24.
3. Sastry J, Kellie SJ. Severe neurotoxicity, ototoxicity and nephrotoxicity following high-dose cisplatin and amifostine. Pediatr Hematol Oncol 2005;22:441–5.
4. Beladi Mousavi SS, Alemzadeh-Ansari MJ, Alemzadeh-Ansari MH. Long-term survival of patients with end-stage renal disease on maintenance hemodialysis: a multicenter study in Iran. Iran J Kidney Dis 2012;6:452-6.
5. Beladi Mousavi SS, Beladi Mousavi M, Hayati F, Talebzadeh M. Effect of Intranasal DDAVP in Prevention of Hypotension during Hemodialysis. Nefrologia 2012;32:89-93.
6. Feily A, Dormanesh B, Ghorbani AR, Moosavi Z, Kouchak M, Kouchak M, et al. Efficacy of topical cromolyn sodium 4% on pruritus in uremic nephrogenic patients: A randomized double-blind study in 60 patients. Int J Clin Pharmacol Ther 2012;50:510-3.
7. Beladi Mousavi SS, Alemzadeh Ansari MJ, Cheraghian B. Outcome of Patients on Hemodialysis in Khuzestan, Iran.  NDT Plus 2011;4:143-4.
Tamadon MR, Beladi-Mousavi SS. Erythropoietin; a review on current knowledge and new concepts. J Ren Inj Prev 2013;2:119-21.
9. Beladi Mousavi SS, Sametzadeh M, Hayati F,Fatemi SM. Evaluation of acquired cystic kidney disease in patients on hemodialysis with ultrasonography. Iran J Kidney Dis 2010;4:223-6.
10. Beladi Mousavi SS, Tavazoe M, Hayati F, Sametzadeh M. Arterio-Venous fistula recirculation in hemodialysis: causes and prevalences. Shiraz E-Med J 2010;11:219-24.
11. Ciarimboli G, Ludwig T, Lang D, Pavenstädt H, Koepsell H, Piechota HJ, et al. Cisplatin nephrotoxicity is critically mediated via the human organic cation transporter 2. Am J Pathol 2005; 167:1477-84.
12. Portilla D, Safar M, Shanon M, Penson R, Palevsky P, Sheridan A. Cisplatin nephrotoxicity. Available from: