Comparison of Rapid Hydration and Standard Hydration Prior to Ifosfamide Administration in Pediatric Patients: A Safety and Efficacy Study.

OBJECTIVES

Adequate hydration status prior to chemotherapy initiation prevents nephrotoxicity in patients receiving potentially nephrotoxic regimens. The purpose of this study was to evaluate the time to initiation of ifosfamide administration between patients receiving standard 6-hour pre-hydration versus 1-hour rapid pre-hydration.

METHODS

A retrospective study was conducted to determine the primary endpoint of time to ifosfamide administration. Patients 1 to 21 years of age who received ifosfamide with standard 6-hour pre-hydration (125 mL/m/hr for 6 hours) between September 2017 and January 2018 or 1-hour rapid pre-hydration (750 mL/m/hr for 1 hour) between September 2018 and March 2019 were included. Secondary endpoints included the incidence of hemorrhagic cystitis, incidence of acute kidney injury (AKI), urine specific gravity, amount of time that ifosfamide was delayed from the originally scheduled administration time, the number of times ifosfamide was delayed greater than 4 hours from the originally scheduled administration time, and length of stay.

RESULTS

A total of 128 patients were included; 68 patients received standard 6-hour pre-hydration and 60 patients received 1-hour rapid pre-hydration prior to ifosfamide administration. Time to ifosfamide administration was reduced from an average of 9.3 hours to 2.4 hours (p < 0.0001). There was no incidence of hemorrhagic cystitis or AKI in either group.

CONCLUSIONS

The 1-hour rapid pre-hydration protocol significantly reduced the time to ifosfamide administration without an increase in adverse effects.