Incidence of Ifosfamide-induced Nephrotoxicity: Comparison of Adult and Pediatric Patients
The alkylating agent Ifosfamide (IFO) used in treatment for a number of malignancies induces nephrotoxicity in a significant number of patients. Nephrotoxicity can prevent delivery of further chemotherapy or, in cancer survivors, increase the risk of osteoporosis and renal failure. The nephrotoxin is chloroacetaldehyde, a metabolite of IFO formed via cytochrome P450 (CYP) 3A4/5. Pediatric patients are typically more susceptible to IFO nephrotoxicity due to the higher doses of IFO, age related differences in survival after IFO treatment, previous treatment with other nephrotoxins (e.g. cisplatin), or metabolism of CYP 3A5. The purpose of the retrospective chart review is to compare the incidence of IFO-induced nephrotoxicity of adult and pediatric patients while adjusting for risk factors of IFO nephrotoxicity (i.e. cumulative IFO dose, and risk factors of renal dysfunction). IRB approval was obtained. Data collected from UWMC and CHMC patients who have had IFO chemotherapy with no more than one in six cycles outside UWMC or CHMC are eligible. Method of research is by reviewing the data on patient clinical features, courses of chemotherapy, nephrotoxicity during and following treatment with IFO and record into Excel. Clinical features include date of birth, sex, race, past medical history of renal disease/ hypertension/diabetes. Chemotherapy history data included the date IFO was given, number of cycles, cumulative IFO dose and whether altered IFO dose from one cycle to the next, other medication and chemotherapy used with IFO. Signs of nephrotoxicity is evaluated by reviewing the electrolytes (serum potassium, magnesium, creatinine, phosphorous, bicarbonate, calcium) along with urine glucose, protein, phosphate, pH, osmolality, creatinine clearance and iothalomate clearance. Renal toxicity will be graded based on the NCI Common Toxicity Criteria and the scale used by Marina et al. Currently 418 adult charts are being reviewed.
