Predictive risk factors of acute kidney injury after cytoreductive surgery and cisplatin-based hyperthermic intra-peritoneal chemotherapy for ovarian peritoneal carcinomatosis

Abstract

ObjectiveThe aim of our study was to assess the incidence and identify the predictive risk factors of acute kidney injury after cytoreductive surgery and cisplatin-based hyperthermic intra-peritoneal chemotherapy.MethodsThis is a retrospective study from two centers evaluating patients with advanced or recurrent ovarian cancer who underwent cytoreductive surgery followed by cisplatin-based hyperthermic intra-peritoneal chemotherapy from January 2007 to December 2013. Patients were classified into two groups according to the occurrence of acute kidney injury, defined as a glomerular filtration rate at post-operative day 7 25% lower than at day 0. We also evaluated acute kidney injury following Risk, Injury, Failure, Lost and End-stage kidney function criteria. Univariate and multivariate analyses were conducted in order to assess the association between different variables and the occurrence of acute kidney injury.ResultsSixty-six patients were included: 29 (44%) underwent first-line treatment and 37 (56%) were treated for recurrent disease. The incidence of post-operative acute kidney injury was 48%. After multivariate analysis, hypertension (OR 18.6; 95% CI 1.9 to 182.3; p=0.012) and low intra-operative diuresis (OR 0.5; 95% CI 0.4 to 0.8; p=0.001) were associated with acute kidney injury.ConclusionThe incidence of acute kidney injury after cytoreductive surgery and cisplatin-based hyperthermic intra-peritoneal chemotherapy was high. Hypertension and low intra-operative diuresis were independent risk factors for this complication. Adequate peri-operative hydration, in order to maintain correct diuresis, could decrease the occurrence of acute kidney injury in patients undergoing cytoreductive surgery plus hyperthermic intra-peritoneal chemotherapy.

Incidence, Risk Factors, and Outcomes of Transition of HIPEC- Induced Acute Kidney Injury to Acute Kidney Disease: A Retrospective Study

“…The incidences of HIPEC-induced AKI varied between 1% and 48% [12,13] widely. In this paper, we detected that 21.5% of patients experienced AKI after the CRS-HIPEC procedure.…”

“…Nevertheless, the incidence of postoperative complications remains high, signi cantly in uencing the survival of patients [10,11]. To date, only a handful of studies revealed the morbidity of perioperative complications such as AKI, ranging from 1% to 48% [12,13]. Independent risk factors for HIPECassociated AKI have been revealed, consisting of age, body mass index (BMI), baseline serum creatinine (SCr), estimated glomerular ltration rate (eGFR), preoperative albumin (ALB), intraoperative bleeding loss, and nephrotoxicity of intraperitoneal cisplatin therapy [14][15][16][17][18].…”

Acute Kidney Injury After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy in a Portuguese Population

“…Some reviews showed that hydration remains the most effective strategy to prevent nephrotoxicity in patients treated with cisplatin [ 26 , 27 ]. We did not find an association between the development of AKI and intraoperative blood loss, or crystalloid reposition during procedure.…”

“…Sodium thiosulfate has also been used to prevent cisplatin nephrotoxicity during HIPEC procedure [ 26 ]. However, since this prophylaxis was not performed in our population, we have no data on this.…”

Society of Onco-Anaesthesia and Perioperative Care consensus guidelines for perioperative management of patients for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC)

“…The incidence of acute kidney injury (AKI) after CRS-HIPEC ranges from 21.3% to 48%. [4445] Higher age, higher BMI, use of preoperative pregabalin, platinum-based chemotherapy, major blood loss, hypertension and low intraoperative diuresis were predictors of development of AKI. The incidence of AKI was 3.7% following cisplatin-based (50 mg/m 2 ) HIPEC.…”