Cisplatin nephrotoxicity in cervical and ovarian cancer: Incidence, risk factors, and prevention in a resource-limited setting

Background Cisplatin induced nephrotoxicity affects approximately 30% of treated patients and remains the primary dose limiting toxicity of this essential chemotherapeutic agent. In resource-limited settings, inconsistent implementation of prevention protocols may increase nephrotoxicity risk, yet prospective data from African populations remain scarce. Methods We conducted a prospective cohort study of 76 women with cervical or ovarian cancer receiving cisplatin based chemotherapy at Tikur Anbessa Specialized Hospital (TASH), Ethiopia. Comprehensive risk factor assessment included demographic, clinical, and treatment related variables. All patients received standardized prevention protocols including intravenous hydration (2.5–3.5 L normal saline per cycle), antiemetic prophylaxis, and serial renal function monitoring. The primary outcome was the incidence of cisplatin induced nephrotoxicity graded by creatinine elevation according to CTCAE v5.0 criteria. Secondary outcomes included risk factor associations and prevention strategy effectiveness. Results The cohort comprised 45 cervical (59.2%) and 31 ovarian (40.8%) cancer patients with mean age 52.4 ± 11.8 years. All 76 enrolled patients completed the primary treatment monitoring period. Despite universal hydration, nephrotoxicity of any grade occurred in 76.3% (58/76), predominantly Grade 1 (56.6%, 43/76). Severe nephrotoxicity (Grade ≥3) occurred in only 5.3% (4/76), with no Grade 4 events. Independent risk factors for moderate to severe nephrotoxicity included baseline eGFR <75 mL/min/1.73m 2 (OR 4.72, 95% CI 1.89–11.78, p = 0.001), advanced age ≥60 years (OR 3.41, 95% CI 1.28–9.07, p = 0.014), and cumulative cisplatin dose >200 mg/m 2 (OR 2.93, 95% CI 1.14–7.52, p = 0.025). Magnesium supplementation was associated with reduced nephrotoxicity severity (p = 0.042). The mannitol forced diuresis subgroup showed lower 48-h creatinine elevation compared to hydration alone (0.18 ± 0.11 vs 0.31 ± 0.18 mg/dL, p = 0.038). Conclusions In this Ethiopian cohort, cisplatin induced nephrotoxicity was common when assessed by serial creatinine monitoring, but implementation of structured prevention protocols effectively limited progression to clinically significant renal impairment. Baseline renal function, age, and cumulative dose independently predicted nephrotoxicity risk. These findings support the feasibility of safe cisplatin administration in resource-limited settings through protocolized prevention strategies.