Ifosfamide-induced nephrotoxicity in oncological patients

ABSTRACT

Introduction

Ifosfamide is an alkylating chemotherapeutic agent used in the treatment of various neoplasms. Its main adverse effects include renal damage.

Areas covered

A comprehensive review was conducted, including 100 articles from the Scielo, Scopus, and EMBASE databases. Ifosfamide-induced nephrotoxicity is attributed to its toxic metabolites, such as acrolein and chloroacetaldehyde, which cause mitochondrial damage and oxidative stress in renal tubular cells. Literature review found a 29-year average age with no gender predominance and a mortality of 13%. Currently, no fully effective strategy exists for preventing ifosfamide-induced nephrotoxicity; however, hydration, forced diuresis, and other interventions are employed to limit renal damage. Long-term renal function monitoring is essential for patients treated with ifosfamide.

Expert opinion

Ifosfamide remains essential in neoplasm treatment, but nephrotoxicity, often compounded by coadministered drugs, poses diagnostic challenges. Preventive strategies are lacking, necessitating further research. Identifying timely risk factors can mitigate renal damage, and a multidisciplinary approach manages established nephrotoxicity. Emerging therapies may reduce ifosfamide induced nephrotoxicity.

Plain Language Summary

Ifosfamide is a type of chemotherapy used to treat different types of cancers. However, one of its main side effects is kidney damage. Researchers reviewed 100 articles from medical databases to understand how ifosfamide affects the kidneys. The kidney damage is caused by harmful substances produced when ifosfamide is broken down in the body. These substances can harm the cells in the kidneys. Studies have shown that 13% of the patients treated with ifosfamide can die. Currently, there is no perfect way to prevent kidney damage from ifosfamide, but doctors try to protect the kidneys by giving patients plenty of fluids and using other treatments, so it’s important for patients who receive ifosfamide to have their kidney function checked regularly. Although ifosfamide is effective against cancer, its potential kidney side effects should be carefully considered by doctors when deciding on the best treatment for each patient.

KEYWORDS:

• Ifosfamide
• Fanconi syndrome
• nephrogenic diabetes insipidus
• neoplasms
• drug-related side effects and adverse reactions

Article highlights

• Ifosfamide-induced nephrotoxicity most commonly presents as proximal tubular dysfunction.

• Nephrotoxicity involves mitochondrial damage in kidneys caused by chloroacetaldehyde.

• Risk factors include nephrectomy, cisplatin use, renal irradiation, and high cumulative ifosfamide doses.

• There are no effective preventive strategies for ifosfamide-induced nephrotoxicity.

• Long-term renal function monitoring is essential in patients who use ifosfamide.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosure

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

JE Quiroz-Aldave: conceptualization, methodology, investigation, writing – original draft, project administration; MC Durand-Vásquez: investigation, writing – original draft; FS Chávez-Vásquez: investigation, writing – original draft; CC Alcalde-Loyola: investigation, writing – original draft; AN Rodríguez-Angulo: investigation, writing – original draft; SE Gonzáles-Saldaña: investigation, writing – original draft; JC Coronado-Arroyo: investigation, writing – original draft; FE Zavaleta-Gutiérrez: investigation, writing – review & editing; LA Concepción-Urteaga: investigation, writing – review & editing; JC Haro-Vargas: investigation, writing – review & editing; MJ Concepción-Zavaleta: conceptualization, methodology, investigation, writing – review & editing, project administration.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/14737140.2023.2290196

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This paper was not funded.