Condition Deep-Dives 11 min read·Updated 22 July 2026 Clinician-reviewed

Cisplatin Nephrotoxicity

A UK Consultant Nephrologist on cisplatin-induced kidney injury — the commonest dose-limiting toxicity of one of oncology's most effective chemotherapies.

  • Clinically Reviewed
  • NHS & NICE Aligned
  • UK Evidence-Based
  • Last Reviewed 22 July 2026

Professor Mohammed Mahdi Althaf

Consultant Nephrologist & Acute Physician

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Professor Mohammed Mahdi Althaf

MD, MSc, PgDip (Clin Ed), FRCP, FHEA, FASN

Consultant Nephrologist & Acute Physician · GMC 7216325

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Direct answer

Up to 30% develop AKI; magnesium wasting affects > 50%. Prevent with vigorous saline hydration, electrolyte replacement and avoiding co-nephrotoxins. Switch to carboplatin if eGFR < 60 or repeated AKI.

Key recommendation: Proximal tubular toxicity is dose-cumulative.

Quick answer

✓ Best choices

  • Adequate fluids once your team confirms it is safe (often 1.5–2 L/day)
  • Easily digested, nutrient-dense meals during recovery
  • Vegetables, fruit, oats and whole grains as appetite returns
  • Protein in modest portions — typically 0.8–1.0 g/kg/day unless advised otherwise

✓ Foods to limit

  • NSAIDs (ibuprofen, naproxen, diclofenac) — they are nephrotoxic
  • Very salty, processed or ultra-processed foods
  • Alcohol while bloods are still recovering

Key takeaway

Up to 30% develop AKI; magnesium wasting affects > 50%. Prevent with vigorous saline hydration, electrolyte replacement and avoiding co-nephrotoxins. Switch to carboplatin if eGFR < 60 or repeated AKI.

Who should be cautious

People on dialysis, post-transplant, pregnant or breastfeeding, or taking prescription medication — confirm with your renal team before changes.

Cisplatin Nephrotoxicity

Mechanism & risk factors

Mechanism

  • Active uptake into proximal tubular cells via OCT2 transporter
  • Mitochondrial dysfunction → apoptosis and necrosis
  • Inflammation, oxidative stress, renal vasoconstriction
  • Magnesium wasting from injured TAL and DCT

Risk Factors

  • Cumulative dose > 200 mg/m²
  • Pre-existing CKD or AKI
  • Age > 65
  • Hypoalbuminaemia, hypomagnesaemia, volume depletion
  • Concurrent NSAIDs, aminoglycosides, IV contrast
  • Female sex

Clinical Syndromes

  • AKI (commonest, days 3–7)
  • Hypomagnesaemia (> 50%; can cause tetany, seizures)
  • Hypokalaemia, hyponatraemia (salt wasting)
  • Fanconi syndrome (glycosuria, phosphaturia, aminoaciduria)
  • Distal RTA
  • Chronic interstitial fibrosis → CKD
  • Rarely TMA, especially with bleomycin combinations

Prevention & monitoring

Pre-infusion

  • Confirm baseline eGFR (ideally EDTA-GFR if borderline)
  • Replete Mg, K, volume
  • Stop NSAIDs; hold ACE-i if dehydration risk
  • 1–2 L 0.9% saline over 2–4 h before dose

During / Post

  • Maintain UO > 100 mL/h (1–2 L saline post)
  • ± Mannitol 12.5–25 g (high-risk protocols)
  • Daily U&Es, Mg, phosphate during admission

Inter-cycle

  • eGFR and Mg before EVERY cycle
  • Urine ACR baseline and at completion
  • Oral magnesium glycerophosphate to maintain Mg > 0.6 mmol/L
  • Audiology baseline (ototoxicity is dose-related)

Long-term

  • eGFR and ACR at 3, 6, 12 months post-completion
  • Lifetime CKD surveillance — many remain stage 3

Dose modification & alternatives

Hold / Reduce

  • Creatinine ↑ > 25% baseline → hold one cycle, rehydrate, reassess
  • eGFR 30–60 → 50–75% dose reduction or switch
  • eGFR < 30 → carboplatin
  • Persistent Mg replacement need > 6 weeks → review

CARBOPLATIN (renal-sparing alternative):

  • Calvert formula: dose = AUC × (GFR + 25)
  • Use EDTA or 24-h creatinine clearance for GFR
  • Far less nephrotoxic but more myelosuppressive

PROTECTIVE STRATEGIES (variable evidence):

  • Hypertonic saline + mannitol
  • Amifostine (licensed; cost-limited in UK)
  • N-acetylcysteine — NO clear benefit
  • Theophylline, sodium thiosulfate — investigational

UK Pathway

  • Oncology + Acute Kidney Injury team if Cr rise > 25%
  • Nephrology referral for unresolved AKI, persistent electrolyte loss or Fanconi syndrome
  • Document baseline GFR before each platinum cycle (RCP/NICE QS guidance)
Aminoglycoside Nephrotoxicity
Related reading: Aminoglycoside Nephrotoxicity.

Key practical tips

Designed for quick scanning — what to order, what to avoid, sensible portions, common mistakes.

  • Follow the NHS sick-day rules: stop ACE inhibitors, ARBs, NSAIDs and diuretics when dehydrated
  • Re-check eGFR at 3 and 6 months as NICE recommends
  • Tell every clinician you see that you have had AKI

Clinical guidance

TL;DR summary

Up to 30% develop AKI; magnesium wasting affects > 50%. Prevent with vigorous saline hydration, electrolyte replacement and avoiding co-nephrotoxins. Switch to carboplatin if eGFR < 60 or repeated AKI.

Key takeaways
  • Proximal tubular toxicity is dose-cumulative.
  • Mg wasting (> 50%) often outlasts the AKI itself.
  • Saline 1–2 L pre and post dose is mandatory.
  • Hold for creatinine rise > 25% or eGFR < 50.
  • Carboplatin is the renal-sparing alternative.
Kidney Diet & Nutrition Considerations

After acute kidney injury (AKI) the priority is recovery: rehydration, treating the underlying cause, stopping nephrotoxins and giving the kidneys a calm nutritional environment. Once eGFR is recovering, a balanced Mediterranean-style diet with sensible salt, sensible protein and good hydration supports healing — and reduces the risk of AKI tipping into long-term CKD.

Foods to prioritise

  • Adequate fluids once your team confirms it is safe (often 1.5–2 L/day)
  • Easily digested, nutrient-dense meals during recovery
  • Vegetables, fruit, oats and whole grains as appetite returns
  • Protein in modest portions — typically 0.8–1.0 g/kg/day unless advised otherwise

Foods to limit

  • NSAIDs (ibuprofen, naproxen, diclofenac) — they are nephrotoxic
  • Very salty, processed or ultra-processed foods
  • Alcohol while bloods are still recovering

Potassium, phosphate and protein needs vary between individuals — please confirm personal targets with your renal team or dietitian. Browse the Kidney Diet Hub for more guides in this cluster.

Frequently asked questions

What is cisplatin nephrotoxicity?

Cisplatin is a platinum chemotherapy used for testicular, ovarian, lung, bladder, head & neck and other solid tumours. Up to 30% of unprotected patients develop AKI after a single dose, mediated by proximal tubular cell apoptosis, vasoconstriction and inflammation. Manifestations include AKI, dose-related CKD, magnesium wasting (Mg < 0.5 mmol/L in > 50%), Fanconi syndrome, salt wasting and rarely TMA.

How is it prevented?

Vigorous saline hydration (1–2 L 0.9% saline before and after dose), maintain urine output > 100 mL/h, IV magnesium and potassium supplementation, avoid concurrent nephrotoxins (NSAIDs, aminoglycosides, IV contrast). Mannitol or furosemide are used in some protocols. Dose cap (typically ≤ 100 mg/m² per cycle) and consider carboplatin for eGFR < 60 or prior cisplatin AKI. Amifostine is licensed but rarely used in the UK.

When should it be stopped or switched?

Hold cisplatin if creatinine rises > 25% from baseline or eGFR falls below 50–60 mL/min/1.73m². Switch to carboplatin (dosed by Calvert formula using EDTA-measured GFR) for ongoing therapy in CKD. Persistent Fanconi syndrome, ongoing AKI or symptomatic hypomagnesaemia despite supplementation are indications to discontinue.

Is the kidney damage reversible?

Acute injury often partially recovers over weeks but a stepwise decline in eGFR with each cycle is typical, and 30–40% have persistent CKD years later. Magnesium wasting can persist indefinitely and may require lifelong oral magnesium. Surveillance with eGFR, urine ACR and electrolytes for at least 1 year after completion.

What should I eat to recover from acute kidney injury?

Most adults recovering from AKI do best on a balanced Mediterranean-style diet with adequate hydration (once your team confirms it's safe), moderate protein (around 0.8–1.0 g/kg/day), lower salt, and avoidance of NSAIDs. Your renal team will give you personalised fluid and protein targets based on your recovery.

Nutritional challenges in kidney disease

Many people living with kidney disease have to limit foods because of potassium, phosphate, diabetes, dialysis, appetite changes or simply the time it takes to cook from scratch every day. That can make it harder to keep daily nutrition balanced — particularly for vitamins and minerals that food alone may not fully cover.

Kidney Vitality is a UK-formulated daily nutritional support product designed by Consultant Nephrologist Professor Mohammed Mahdi Althaf with renal nutrition in mind from the start. It keeps doses moderate, leaves out added potassium, phosphate and magnesium, and avoids megadose vitamin A — sitting alongside a kidney-friendly diet, not replacing it.

Why Kidney Vitality fits this need

Built around UK guidance

Aligned with NICE NG148 (AKI), British Oncology Pharmacy Association cisplatin handling, and KDIGO 2024 CKD evaluation.

Designed by a UK Consultant Nephrologist

Formulated and reviewed by Professor Mohammed Mahdi Althaf (GMC 7216325).

Prevention-first & dose-aware

Practical hydration protocols, monitoring schedule and switch criteria for the onco-nephrology MDT.

Designed by a UK Consultant Nephrologist

Ready to support your kidney health?

If you have been researching kidney health, supplements, CKD nutrition or kidney-friendly living, Kidney Vitality was developed specifically around those principles by Professor Mohammed Mahdi Althaf (GMC 7216325). Nephrologist Developed Daily Multivitamin.

  • No Added Potassium
  • No Added Magnesium
  • No Added Phosphorus
  • No Added Iron
  • One capsule daily
  • UK GMP — BRCGS, NSF GMP, Halal
Subscribe & Save — £20.39/monthCheck your current multivitamin

✓ Free UK tracked delivery  ·  ✓ Delivered every 30 days  ·  ✓ Pause or cancel anytime  ·  ✓ Never run out

ComparisonKidney VitalityTypical high-street multivitamin
Added potassiumNoneOften included
Added phosphateNoneOften included (E338–E452)
Vitamin A (retinol)No megadoseOften high-dose retinol
Kidney-focused formulationYesNo — general population
Consultant Nephrologist involvementYes (GMC 7216325)No
UK GMP manufacturedYes (BRCGS, NSF GMP)Varies

Food supplement. Not a medicine and not a treatment for kidney disease. Speak with your GP, pharmacist or renal team before starting any new supplement, especially in advanced CKD, on dialysis, post-transplant, pregnant or breastfeeding.

Clinical reviewer

Professor Mohammed Mahdi Althaf

Consultant Nephrologist

Acute Physician

GMC 7216325

View Full Biography

Professor Mohammed Mahdi Althaf is a UK Consultant Nephrologist and Acute Physician with a special interest in chronic kidney disease, AKI prevention and renal nutrition. He combines hospital practice with patient education and clinical guidance review.

View professional profile →
View Credentials
  • MD
  • MSc
  • PgDip (Clin Ed)
  • FRCP
  • FHEA
  • FASN

About this article

Written for UK patients and based on:

  • NICE guidance
  • NHS resources
  • British Dietetic Association guidance
  • Kidney Care UK resources
View methodology

Each article is researched against current UK clinical guidance (NICE NG203, NG118, NG136), NHS patient resources, KDIGO and KDOQI international guidelines, and the British Dietetic Association Renal Nutrition Group. Drafts are written by the Kidney Vitality editorial team and reviewed by a UK Consultant Nephrologist before publication. Content is reviewed on a rolling basis and updated when guidance changes.

Editorial standards

  • Clinically reviewed
  • NHS-aligned
  • NICE-aligned
  • Evidence-based
  • Reviewed before publication
View full editorial process

Every article is researched and written by the Kidney Vitality editorial team using current UK clinical guidance (NICE NG203, NG118, NG136), NHS patient resources, KDIGO/KDOQI international guidelines, and British Dietetic Association renal nutrition guidance. Drafts are reviewed for clinical accuracy by Professor Mohammed Mahdi Althaf, MD, MSc, PgDip (Clin Ed), FRCP, FHEA, FASN (Consultant Nephrologist & Acute Physician, GMC 7216325) before publication. Content is updated when UK guidance changes.

References (4)View Sources
  1. NICE NG203: Chronic kidney disease — assessment and management
  2. KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of CKD
  3. KDOQI Clinical Practice Guideline for Nutrition in CKD: 2020 Update
  4. British Dietetic Association — Renal Nutrition Group

Medical disclaimer

This content is educational only and does not replace personalised medical advice.

Read full disclaimer

This page is general information, not personal medical advice. If you have chronic kidney disease, are on dialysis, have had a kidney transplant, are pregnant or breastfeeding, or take prescription medication, please confirm any supplement with your GP, pharmacist or renal team before starting.

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