The Nephroprotective Effect of Metformin With Cisplatin in Bladder Cancer

Inclusion criteria

• Non-diabetic adults of age between 18 to 65.
• Chemotherapy naïve patients diagnosed with bladder cancer.
• Patients with stable renal function: eGFR is above 60 ml/min/1.73 m2

Exclusion criteria

• Patients with history of lactic acidosis.
• Patients taking any nephrotoxic medication other than cisplatin (e.g., frusemide, NSAIDs, aminoglycoside or vancomycin).
• Unstable renal function (defined as an increase in serum creatinine of 0.3 mg/dL or greater suddenly in 48 hours according to the acute kidney injury network (AKIN) classification
• Patients with heart failure, acute myocardial infarction or cardiogenic collapse (shock).
• Severe infection and sepsis.

• Any infection requiring hospitalization.
• Any infection leading to a need for oxygen, intubation, vasopressors or fluids to support blood pressure.
• Alcohol intake.
• Respiratory failure.
• Severe hepatic impairment (Child-Pugh class C).
• Patients with metastasis.