Intravenous Magnesium and Cisplatin-associated Acute Kidney Injury

This presentation discusses all the phases of the multicenter cohort study “Intravenous Magnesium and Cisplatin-Associated Acute Kidney Injury” (Gupta et al., JAMA Oncology, 2025), which evaluated the association between prophylactic intravenous (IV) magnesium administration and the risk of cisplatin-associated acute kidney injury (CP-AKI) in patients with cancer. CP-AKI is a common and clinically relevant complication of cisplatin chemotherapy, associated with increased morbidity, mortality, and treatment modification. While preclinical studies suggest a nephroprotective role of magnesium, its effectiveness in routine clinical practice has remained uncertain. The study included 13,719 adult patients receiving a first dose of IV cisplatin at five US cancer centers between 2006 and 2022; 28.4% received prophylactic IV magnesium on day 1 (median dose 2 g). The primary outcome was a composite of CP-AKI or death within 14 days, defined by a twofold increase in serum creatinine or initiation of kidney replacement therapy. Analyses used inverse probability of treatment weighting with adjustment for relevant clinical and treatment-related confounders. CP-AKI or death occurred less frequently among patients who received IV magnesium compared with those who did not (2.7% vs 5.3%), with a significantly lower adjusted risk. Findings were consistent across sensitivity analyses and secondary kidney outcomes, including major adverse kidney events at 90 days. Overall, this large multicenter analysis highlights CP-AKI as a frequent and potentially modifiable complication of cisplatin therapy and confirms the effectiveness of prophylactic IV magnesium administration in reducing the risk of CP-AKI.