Effectiveness of mannitol in preventing acute kidney injury among patients with cervical cancer stage 1B to 2B receiving concurrent chemoradiation at Moi Teaching Referral Hospital and Eldoret Hospital

Abstract

Background: Cervical cancer is the leading cause of cancer deaths in women with 90% occurring in low and middle-income countries. The gold standard of treatment for locally advanced cervical cancer is concurrent chemoradiation with cisplatin, cisplatin serves as a radiosensitizer.However, cisplatin is known to be toxic to the kidney,leading to dose delays and treatment cessation. This study aims to determine whether mannitol prevents Cisplatin induced acute kidney injury during chemoradiation therapy for cervical cancer. Objective: To evaluate the effectiveness of Mannitol using the rate of averted acute kidney injury and completion rate among patients with cervical cancer undergoing chemoradiation treatment in MTRH and Eldoret Hospital. Methods: It was a double blind randomized clinical trial study involving 50 women with cervical cancer stage 1B up to 2B underwent chemoradiation at MTRH and Eldoret Hospital. Patients were naive to chemotherapy and radiotherapy. Patients were randomly assigned into two arms of 25 each (intervention and control). Intervention arm received mannitol 20% (200mls) with standard chemotherapy regimen (Cisplatin 40mg/m2) and the control arm received standard chemotherapy regimen as per the protocol along with 200mls of Normal Saline as placebo. All patients underwent 25 sessions of external beam radiation at 1 to 1.5 Grays per session. Weekly kidney function of patients was collected. Data was collected using structured questionnaire and analyzed. The outcome measured was the rate of averted acute kidney injury and the time of chemotherapy completion in both arms. Results: The average age in the control and intervention group was 52.8 and 50.6 The rate of averted AKI was 96% in the intervention arm and 92% in the control arm.The time of chemoradiation completion was the same among both arms. Conclusion: We do not have enough evidence to conclude that the proportion with averted AKI or the time to completion differed between the two groups. Recommendation: Further studies should be done to evaluate the effectiveness of Mannitol in preventing of CIN and AKI.