Cisplatin nephrotoxicity. Correlation with plasma platinum concentrations

Plasma platinum concentrations were measured in 45 patients receiving 46 courses of cisplatin (DDP) 100-120 mg/m2 and in 21 patients receiving 35-60 mg/m2. Samples were drawn 5 minutes, 24, and 48 hours following completion of the DDP infusion. Nephrotoxicity was defined as a greater than 50% increase in serum creatinine measured at 24 and/or 48 hours when compared to the baseline pretreatment value. In patients receiving DDP 100-120 mg/m2, 5/20 with 5-minute plasma platinum concentrations greater than 6 micrograms/ml developed nephrotoxicity; 0/26 with concentrations less than 6 micrograms/ml became nephrotoxic (p less than 0.05). Concentrations at 24 and 48 hours in toxic and nontoxic patients were similar. Five-minute plasma platinum concentrations in excess of 6 micrograms/ml did not occur in the 21 patients receiving DDP 35-60 mg/m2. Only one of these 21 patients became nephrotoxic. The data suggest that an increased incidence of acute nephrotoxicity is related to high peak plasma platinum concentrations.