Prevention and Management of Carboplatin Nephrotoxicity

Carboplatin, a second-generation platinum-based therapy, is widely indicated for first-line treatment of selected solid tumors. Furthermore, it represents a well-established alternative to cisplatin in populations characterized by chronic kidney disease (CKD) or clinical frailty. The renal profile of carboplatin toxicity is most commonly linked to hypomagnesemia, and less frequently to acute kidney injury (AKI) or a persistent decline in GFR. While hypomagnesemia is the most frequent renal adverse effect, severe episodes that impact anticancer treatment are uncommon. Reductions in GFR carry significant clinical implications because they directly affect carboplatin dosing and drive cumulative hematologic toxicity that leads to adverse clinical events, which may be more relevant in older and sarcopenic patients. Carboplatin toxicity is highly dependent on systemic exposure and is quantified by the area under the concentration-time curve (AUC). Inaccurate estimation of GFR, particularly when using the Cockcroft-Gault (CG) equation, frequently leads to GFR overestimation and carboplatin overdose. Thus, precise dose adjustment according to GFR is of the utmost importance. In this review, we examine the renal complications associated with carboplatin, including the reported incidence and clinical patterns of kidney injury, with particular emphasis on dose-adjustment strategies based on GFR, encompassing patients with CKD and those receiving dialysis, as well as practical considerations for the prevention and management of carboplatin nephrotoxicity.