Authors (including presenting author) :
Sun HS(1), Chu LM(1), Young WM(1), Tse PL(1), Wong CS(2), Chan PC(2), Cheung KW(2)
Affiliation :
(1) Department of Pharmacy (2) Department of Clinical Oncology, Tuen Mun Hospital
Introduction :
Long hydration Protocol has been adopting in Tuen Mun Hospital (TMH) in preventing high-dose cisplatin-induced nephrotoxicity. In view of increasing evidence supporting short hydration, oncologists and oncology clinical pharmacists have developed a short hydration protocol for patients meeting eligible criteria and has planned to replace long hydration protocol.
Objectives :
(1) To evaluate outcomes of short hydration protocol versus long hydration protocol in preventing cisplatin-induced nephrotoxicity (2) To evaluate cost-effectiveness of short hydration protocol versus long hydration protocol
Methodology :
Retrospective matched cohort was conducted to evaluate outcomes of short hydration protocol versus long hydration protocol in preventing cisplatin-induced nephrotoxicity in nasopharynx cancer patients. This study compared changes in renal function at baseline, during and after chemo-radiotherapy for short hydration group within period of Oct 2018 to Nov 2019 (n = 15) and long hydration group which were matched with similar patient characteristics within period of Oct 2015 to Sep 2018 (n = 30). Length of hospital stay and hospitalization cost for each cisplatin cycle were calculated. Mann-Whitney U-test was used for analysis of continuous and ordinal variables while Fisher’s exact test was used for categorical variables analysis.
Result & Outcome :
Baseline renal function was similar and not significantly different between short hydration and long hydration group (P=0.08 for creatinine clearance (CrCl); P=0.92 for serum creatinine (SrCr) and P=0.54 for estimated glomerular filtration rate (eGFR)). For changes in renal function, median maximum decrement of CrCl, median maximum increment of SrCr and median maximum decrement of eGFR of short hydration group were significantly smaller compared to long hydration group (P=0.002 for CrCl; P< 0.0001 for SrCr and eGFR). Less renal function decline was found for short hydration compared to long hydration. Short hydration was non-inferior to long hydration in preventing cisplatin-induced nephrotoxicity. Mean length of hospital stay for each cisplatin cycle was less in short hydration (2.03 days) compared to long hydration (3.28 days) (P < 0.0001). Mean cost of hospitalization for each cisplatin cycle was significantly less in short hydration ($8177) compared to long hydration ($13197) (P< 0.0001), resulted to net saving of $5020 per patient per cisplatin cycle. Short hydration protocol is safe and cost-effective and clinical oncology department is planning to replace the conventional long hydration protocol in TMH.
