Hydration practices during cisplatin administration: a national multicenter survey

Cisplatin-based chemotherapy remains a cornerstone of cancer treatment, yet optimal strategies to prevent nephrotoxicity through hydration protocols remain controversial. While both long and short hydration regimens are commonly used, no consensus exists on the most effective approach. Emerging data suggest that short hydration protocols may offer comparable nephroprotection while improving quality of life and facilitating outpatient care.

A national, multicenter survey was conducted to evaluate hydration practices among French oncology professionals prescribing cisplatin. A working group of oncologists and nephrologists developed a 28-question survey, covering demographics, hydration protocols, electrolytes and diuretic use, and renal function monitoring. The survey was distributed online between March and June 2024 to medical oncologists, hematologists, radiation oncologists, pharmacists, and other relevant specialists involved in chemotherapy prescribing. Data were analyzed using descriptive statistics and appropriate statistical tests to compare variables.

Among 173 respondents, most were medical oncologists (61%) or radiation oncologists (20%), practicing mainly in university hospitals (38%) or comprehensive cancer centers (22%). Hydration protocols commonly used varied among respondents, with long (> 24 h, 3.5-4L) or short (≤ 4.5 h, 2-2.5L) regimens used by 73% and 16% of respondents respectively. Renal function was most commonly assessed by CKD-EPI (52%) or MDRD (42%). A creatinine clearance threshold of 60 mL/min was used to contraindicate cisplatin by 72% of respondents, especially those with ≤ 10 years of experience (p = 0.015), and 50 mL/min by 24%. Hospital-based hydration was more common in public institutions (p = 0.021), while private centers preferred home-based strategies (p < 0.001). Magnesium (57%) and potassium (37%) were routinely supplemented.

This study highlights the substantial heterogeneity of hydration practices for cisplatin administration in France, contrasting with the increasing international adoption of short outpatient regimens. These findings underscore the need for updated, evidence-based national and international guidelines to harmonize practices, optimize nephroprotection, and facilitate the safe expansion of outpatient and home hydration models.