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Cisplatin is a crucial chemotherapy agent for various cancers, yet it carries a significant risk of causing cisplatin-associated acute kidney injury (CP-AKI), limiting treatment options and increasing toxicity risks. Identifying individuals at high risk for CP-AKI is essential for adjusting treatments and improving participant selection in clinical trials. However, current research on CP-AKI risk factors is hindered by small sample sizes and inconsistent kidney injury definitions. Further research is necessary to refine CP-AKI risk prediction and develop targeted prevention strategies, ensuring safer treatment plans for cisplatin therapy patients.

The study initially analyzed 34,122 patients who received intravenous cisplatin across six institutions, ultimately focusing on 11,766 in the derivation cohort and 12,951 in the validation cohort after exclusions. Baseline characteristics showed similarities between both cohorts, with variations in the prevalence of conditions such as hypertension, diabetes mellitus, congestive heart failure, and cirrhosis, which were more common in the validation cohort. Conversely, chronic obstructive pulmonary disease was more prevalent in the derivation cohort. The median cisplatin dose was higher in the derivation cohort. Secondary outcomes analysis demonstrated consistent discrimination across five additional analyses, with the primary model's discrimination remaining stable at a concordance (C) statistic of 0.75, even after excluding patients with serum creatinine follow-up within four days post-cisplatin administration. Adjustments for secondary outcomes yielded C statistics of 0.71 and 0.74, using more liberal and stricter CP-AKI definitions, respectively. The model consistently outperformed three earlier models in forecasting CP-AKI and was particularly effective in identifying patients at risk for major adverse kidney events within 90 days (C statistic of 0.79). There was a clear association between CP-AKI severity and reduced survival rates at both 90 days and one year, emphasizing its significant impact on survival. Additionally, higher CP-AKI stages were consistently linked with an increased likelihood of major adverse kidney events within a year, highlighting long-term risks. In this notable study, a novel scoring system utilizing nine easily accessible variables successfully distinguishes patients with differing levels of risk for CP-AKI. The research also uncovered new risk factors, such as hypomagnesemia, and emphasized the link between CP-AKI severity and lower survival rates. These findings underscore the significance of precise risk assessment in enhancing patient care and outcomes during cisplatin therapy.