Abstract
Cervical cancer remains a leading cause of cancer-related morbidity and mortality among women in low-resource settings. Chemotherapy is a primary treatment modality, yet its biochemical effects on liver function, kidney function, and electrolyte balance remain underexplored in routine oncology care, particularly in sub-Saharan Africa. This study evaluated longitudinal variations in liver enzymes, kidney function markers, and serum electrolytes among cervical cancer patients receiving chemotherapy at Jaramogi Oginga Odinga Teaching and Referral Hospital in Western Kenya. The study enrolled 60 patients with cervical cancer (aged 23–80 years) at JOOTRH between September 2024 and February 2025. Venous blood was collected at baseline and at three subsequent 21-day chemotherapy cycle intervals. Liver enzymes (ALT, AST, ALP, GGT), kidney function markers (urea, creatinine, eGFR), and electrolytes (sodium, potassium, chloride) were measured using the Cobas Integra 400 Plus chemistry analyzer. Given a non-normal data distribution, as confirmed by the Shapiro-Wilk test, the Friedman test was used for overall longitudinal comparisons, with Wilcoxon signed-rank post hoc tests applying a Bonferroni-Holm correction for liver enzymes and a Bonferroni correction for kidney function and electrolyte parameters; statistical analyses were performed in R (version 4.5.1), with significance set at p < 0.05. Three of four liver enzymes changed significantly over time, with significant elevation confined to the later cycles for ALT (Friedman χ² = 17.428, p = 0.0006) and AST (χ² = 12.898, p = 0.0049), and progressive elevation from the second cycle onward for ALP (χ² = 25.823, p < 0.0001); GGT remained stable throughout (p = 0.299). Kidney function changes were both earlier and more consistent than liver findings: serum creatinine rose significantly from the first cycle onward (χ² = 28.918, p < 0.001), eGFR declined significantly after the first cycle (χ² = 27.438, p < 0.001), and urea rose significantly by the third cycle (χ² = 7.841, p = 0.049). Serum sodium declined progressively, falling from a baseline mean of 135.2 ± 4.2 mmol/L to 131.5 ± 12.2 mmol/L by the third cycle, with the decline reaching significance from the second cycle onward (χ² = 22.151, p < 0.001) and group-level values dropping below the normal reference range of 135–145 mmol/L by the second cycle, potassium and chloride showed no statistically significant change throughout treatment (p = 0.881 and p = 0.333, respectively). Chemotherapy in this cohort was therefore associated with early and sustained deterioration in kidney function markers detectable from the first treatment cycle, changes in liver-associated biochemical parameters emerging from the second and third cycles, and a progressive decline in serum sodium from the second cycle onward. These findings support systematic pre-cycle biochemical monitoring of renal function and serum sodium from the onset of chemotherapy, and of liver enzymes from the second cycle, in low-resource oncology settings where routine monitoring is often inconsistent.