Opinion: IV Magnesium May Help Prevent Cisplatin-Induced AKI

Magnesium can induce drug transporter activity and reduce inflammation as well as oxidative stress.

Oncology nurses frequently administer cisplatin and are well aware of its value in treating a wide range of solid tumors. While its anti-cancer efficacy is well established, cisplatin is also associated with several toxicities, with acute kidney injury (AKI) being one of the most notable. Cisplatin-induced AKI (CP-AKI) is both common and, in some cases, preventable. It can lead to treatment delays, dose reductions, or discontinuation altogether, compromising patient outcomes. Nurses play a critical role in identifying patients at risk, implementing preventive strategies, and recognizing early signs of kidney injury to help preserve renal function and maintain treatment continuity.

Study Explores Protective Effect of Magnesium

A recent study led by Shruti Gupta, MD, MPH and colleagues examined whether intravenous (IV) magnesium could help reduce the risk of CP-AKI.¹ Preclinical studies suggest that magnesium protects kidney cells through several mechanisms. One mechanism involves increasing the activity of drug transporters, proteins on kidney cells that help remove platinum from the cells and into the urine, thereby reducing toxic buildup in the kidney. Magnesium may also reduce inflammation and oxidative stress, an imbalance of harmful molecules called free radicals that damage cells. Despite these findings, previous human studies testing the benefits of magnesium on AKI have been small and lacked the statistical power needed to draw firm conclusions.

This large, multicenter cohort study analyzed data from over 13,000 adult patients who received their first dose of IV cisplatin between 2006 and 2022 across 5 major US cancer centers. The primary objective was to assess whether administration of IV magnesium on the day of cisplatin treatment was associated with a lower risk of moderate to severe CP-AKI or death within 14 days.

After accounting for multiple factors that could influence the results, such as patients’ other comorbidities, their kidney baseline function before treatment began, and use of other nephrotoxic medications that can harm the kidneys, the researchers found that patients who received IV magnesium had significantly lower chances of developing CP-AKI or dying soon after treatment.

Further analysis looked at specific groups of patients and showed that the protective effect of IV magnesium was strongest among patients younger than 65 years, women, those with higher kidney function before treatment, and those who had higher magnesium levels at baseline.

Amanda Brink, DNP, APRN, FNP-BC, AOCNP

The results remained consistent even when the researchers tested different definitions of AKI and examined longer-term kidney outcomes, including major adverse kidney events within 90 days after treatment (known as MAKE90), which include significant worsening of kidney function, the need for dialysis, or death related to kidney problems.

There were some limitations to this study. Because it was an observational study, researchers could not definitively prove that IV magnesium caused the reduction in kidney injury, only that an association existed. The study also only included data from patients’ first cycle of cisplatin treatment, so it remains unclear if the findings apply to later cycles.

Additionally, detailed information about other important factors, such as the amount of intravenous fluids given, use of oral magnesium supplements, or other medications taken at home, was not consistently available. However, the study included data from 5 cancer centers located in different regions of the United States, each with different practices around giving magnesium. This diversity helps make the findings more applicable to a wide range of patients and clinical settings, increasing the study’s generalizability.

Nursing Considerations

This study offers strong evidence that prophylactic IV magnesium, a treatment that is both inexpensive and widely accessible, may significantly reduce the risk of CP-AKI. Given the potential severity of kidney damage and its impact on a patient’s ability to continue effective cancer therapy, magnesium supplementation represents a promising preventive strategy.

Oncology nurses play a key role in advocating for the routine inclusion of magnesium supplementation in cisplatin-based chemotherapy protocols. Nurses can also help educate patients on the purpose of magnesium supplementation and its potential benefits in protecting kidney function and maintaining treatment goals.

References

Gupta S, Glezerman IG, Hirsch JS, et al. Intravenous Magnesium and Cisplatin-Associated Acute Kidney Injury. JAMA Oncol. 2025;11(6):636-643. doi:10.1001/jamaoncol.2025.0756