A Bold Wake-Up Call: Hydration Protocols for Cisplatin Patients vary widely, and that variability carries real risk—and real opportunity for improvement.
Cisplatin remains a staple chemotherapy for many solid tumors, including lung, gastrointestinal, gynecologic, and head-and-neck cancers. A major concern with cisplatin is nephrotoxicity, kidney damage, which can limit treatment effectiveness or require dose reductions. Yet, across oncology practices, there isn’t a universal approach to preventing this kidney toxicity.
A research task force of nephrologists and oncologists surveyed 172 clinicians in France who administer high-dose cisplatin (>50 mg/m2) and shared their findings in Supportive Care in Cancer. The study, led by co–first authors Drs. Paul Matte and Arnaud Saillant from Paris Saclay University, highlights several notable variations in practice.
Key areas where practices diverged:
- Where hydration occurs. Most centers conducted hydration in-hospital to safeguard patient safety and ensure access to resources. About 73% of hospital-based protocols spanned 24 hours and often required an overnight stay. In contrast, about 22% offered at-home hydration, typically when hospital capacity was limited.
- How renal function is evaluated. Just over half (51%) relied on the CKD-EPI equation to gauge kidney function, and many used a glomerular filtration rate (GFR) threshold of 60 mL/min/1.73 m2 to determine cisplatin eligibility. Only 8% incorporated cystatin C as a renal marker, despite evidence suggesting it can provide a more accurate assessment in some patients. More junior prescribers tended to use cystatin C more frequently.
- Types and quantities of hydration. Clinicians reported more than five distinct hydration regimens, with normal saline (87%) and a mixture of normal saline with 5% glucose (24%) being the most common. The median total hydration volume was about 3 liters, but the range extended from 1 to 8 liters. Potassium supplementation was used by 57% of clinicians and magnesium by 37%, though practices varied.
These differences in management could expose patients to different levels of risk related to kidney health and to the logistical and emotional burdens of accessing care. Future research should examine how varying protocols impact nephrotoxicity prevention, adherence to chemotherapy plans, and overall quality of life—especially when balancing in-hospital visits with patient convenience and safety.
This article offers meaningful guidance at a time when there are no universal, international guidelines from major bodies such as ASCO, NCCN, or ESMO. It also raises important clinical questions: What is the optimal way to administer hydration for patients receiving cisplatin? How can nursing practice best reflect evidence to avoid over- or under-treatment while addressing patient social needs?
Oncology nurses are well-positioned to interpret these findings, evaluate how protocols perform in real-world settings, and translate results into routine cancer care that prioritizes both efficacy and patient well-being.
A provocative takeaway is that some steps in hydration protocols may be more rooted in tradition than solid evidence. That invites ongoing dialogue and collaboration between clinical nurses and nursing researchers to advance patient care in cancer settings.
Teresa Hagan Thomas, RN, PhD, welcomes questions and discussion about this article. Interested readers can reach her via the contact listed on Cancer Nursing Today to start a conversation.
References
Matte P, et al. Support Care Cancer. 2025;33(12):1127. doi:10.1007/s00520-025-10189-2
