Do you recommend preloading with IV magnesium to decrease the risk of cisplatin nephrotoxicity?  

There are clinical data that demonstrate nephroprotection when IV Mg is administered with cisplatin. Our center does not routinely administer IV Mg to prevent CIS nephrotoxicity but I have recommended co-administration with IV Mg and CIS in patients with CKD for whom CIS is first-line therapy.

Although there have been studies demonstrating that hypomagnesemia has been associated with an increased risk of AKI, there have been no clinical trials indicating preloading with mag prevents AKI. I would recommend to have the magnesium above 2mg/dl prior to cisplatin.

There is pre-clinical evidence in murine models that suggests a role for magnesium in down-regulating drug transporters which facilitate cisplatin uptake in the proximal tubule. Despite this, there is scarce patient data except for small studies mostly from Japan that suggest reduced AKI risk. Given...