Incidence, Risk Factors, and Outcomes of the Transition of HIPEC-induced Acute Kidney Injury to Acute Kidney Disease: a Retrospective Study

Overview

Journal Ren Fail

Publisher Informa Healthcare

Date 2024 Apr 11

PMID 38604946

Authors

Yunwei Lu

Ziyan Xiao

Xiujuan Zhao

Yingjiang Ye

Shu Li

Fuzheng Guo

Haiyan Xue

Fengxue Zhu

Affiliations

Soon will be listed here.

Abstract

Background: Acute kidney injury (AKI) is recognized as a common complication following cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC). Characterized by prolonged renal function impairment, acute kidney disease (AKD) is associated with a higher risk of chronic kidney disease (CKD) and mortality.

Methods: From January 2018 to December 2021, 158 patients undergoing CRS-HIPEC were retrospectively reviewed. Patients were separated into non-AKI, AKI, and AKD cohorts. Laboratory parameters and perioperative features were gathered to evaluate risk factors for both HIPEC-induced AKI and AKD, with the 90-day prognosis of AKD patients.

Results: AKI developed in 21.5% of patients undergoing CRS-HIPEC, while 13.3% progressed to AKD. The multivariate analysis identified that ascites, GRAN%, estimated glomerular filtration rate (eGFR), and intraoperative (IO) hypotension duration were associated with the development of HIPEC-induced AKI. Higher uric acid, lessened eGFR, and prolonged IO hypotension duration were more predominant in patients proceeding with AKD. The AKD cohort presented a higher risk of 30 days of in-hospital mortality (14.3%) and CKD progression (42.8%).

Conclusions: Our study reveals a high incidence of AKI and AKI-to-AKD transition. Early identification of risk factors for HIPEC-induced AKD would assist clinicians in taking measures to mitigate the incidence.

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References

Desantis M, Bernard J, Casanova V, Cegarra-Escolano M, Benizri E, Rahili A . Morbidity, mortality, and oncological outcomes of 401 consecutive cytoreductive procedures with hyperthermic intraperitoneal chemotherapy (HIPEC). Langenbecks Arch Surg. 2014; 400(1):37-48. DOI: 10.1007/s00423-014-1253-z. View

Bouhadjari N, Gabato W, Calabrese D, Msika S, Keita H . Hyperthermic intraperitoneal chemotherapy with cisplatin: Amifostine prevents acute severe renal impairment. Eur J Surg Oncol. 2015; 42(2):219-23. DOI: 10.1016/j.ejso.2015.07.016. View

Shankar A, Sun L, Klein B, Lee K, Muntner P, Nieto F . Markers of inflammation predict the long-term risk of developing chronic kidney disease: a population-based cohort study. Kidney Int. 2011; 80(11):1231-8. PMC: 3260339. DOI: 10.1038/ki.2011.283. View

Dunser M, Takala J, Ulmer H, Mayr V, Luckner G, Jochberger S . Arterial blood pressure during early sepsis and outcome. Intensive Care Med. 2009; 35(7):1225-33. DOI: 10.1007/s00134-009-1427-2. View

Manohar S, Leung N . Cisplatin nephrotoxicity: a review of the literature. J Nephrol. 2017; 31(1):15-25. DOI: 10.1007/s40620-017-0392-z. View

Fliser D, Laville M, Covic A, Fouque D, Vanholder R, Juillard L . A European Renal Best Practice (ERBP) position statement on the Kidney Disease Improving Global Outcomes (KDIGO) clinical practice guidelines on acute kidney injury: part 1: definitions, conservative management and contrast-induced nephropathy. Nephrol Dial Transplant. 2012; 27(12):4263-72. PMC: 3520085. DOI: 10.1093/ndt/gfs375. View

Chertow G, Burdick E, Honour M, Bonventre J, Bates D . Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. J Am Soc Nephrol. 2005; 16(11):3365-70. DOI: 10.1681/ASN.2004090740. View

Matsuura R, Iwagami M, Moriya H, Ohtake T, Hamasaki Y, Nangaku M . The Clinical Course of Acute Kidney Disease after Cardiac Surgery: A Retrospective Observational Study. Sci Rep. 2020; 10(1):6490. PMC: 7162986. DOI: 10.1038/s41598-020-62981-1. View

Naffouje S, Tulla K, Chorley R, Armstrong N, Salti G . Acute kidney injury increases the rate of major morbidities in cytoreductive surgery and HIPEC. Ann Med Surg (Lond). 2018; 35:163-168. PMC: 6178214. DOI: 10.1016/j.amsu.2018.09.036. View

10.

Bhatt A, Sheshadri D, Chandan G, Ramaswamy V, Pandey J, Bhorkar N . Outcomes of cytoreductive surgery and HIPEC for pseudomyxoma peritonei of appendiceal origin from two Indian centers: A preliminary five-year experience. J BUON. 2017; 22(1):251-257. View

11.

Mehta S, Schwarz L, Spiliotis J, Hsieh M, Akaishi E, Goere D . Is there an oncological interest in the combination of CRS/HIPEC for peritoneal carcinomatosis of HCC? Results of a multicenter international study. Eur J Surg Oncol. 2018; 44(11):1786-1792. DOI: 10.1016/j.ejso.2018.05.021. View

12.

Devereaux P, Yang H, Yusuf S, Guyatt G, Leslie K, Villar J . Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial. Lancet. 2008; 371(9627):1839-47. DOI: 10.1016/S0140-6736(08)60601-7. View

13.

Futier E, Lefrant J, Guinot P, Godet T, Lorne E, Cuvillon P . Effect of Individualized vs Standard Blood Pressure Management Strategies on Postoperative Organ Dysfunction Among High-Risk Patients Undergoing Major Surgery: A Randomized Clinical Trial. JAMA. 2017; 318(14):1346-1357. PMC: 5710560. DOI: 10.1001/jama.2017.14172. View

14.

James M, Grams M, Woodward M, Elley C, Green J, Wheeler D . A Meta-analysis of the Association of Estimated GFR, Albuminuria, Diabetes Mellitus, and Hypertension With Acute Kidney Injury. Am J Kidney Dis. 2015; 66(4):602-12. PMC: 4594211. DOI: 10.1053/j.ajkd.2015.02.338. View

15.

Dalfino L, Tullo L, Donadio I, Malcangi V, Brienza N . Intra-abdominal hypertension and acute renal failure in critically ill patients. Intensive Care Med. 2007; 34(4):707-13. DOI: 10.1007/s00134-007-0969-4. View

16.

Lee L, Alie-Cusson F, Dube P, Sideris L . Postoperative complications affect long-term outcomes after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for colorectal peritoneal carcinomatosis. J Surg Oncol. 2017; 116(2):236-243. DOI: 10.1002/jso.24632. View

17.

van Driel W, Koole S, Sikorska K, Schagen van Leeuwen J, Schreuder H, Hermans R . Hyperthermic Intraperitoneal Chemotherapy in Ovarian Cancer. N Engl J Med. 2018; 378(3):230-240. DOI: 10.1056/NEJMoa1708618. View

18.

McSweeney K, Kate Gadanec L, Qaradakhi T, Ali B, Zulli A, Apostolopoulos V . Mechanisms of Cisplatin-Induced Acute Kidney Injury: Pathological Mechanisms, Pharmacological Interventions, and Genetic Mitigations. Cancers (Basel). 2021; 13(7). PMC: 8036620. DOI: 10.3390/cancers13071572. View

19.

Glehen O, Kwiatkowski F, Sugarbaker P, Elias D, Levine E, de Simone M . Cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for the management of peritoneal carcinomatosis from colorectal cancer: a multi-institutional study. J Clin Oncol. 2004; 22(16):3284-92. DOI: 10.1200/JCO.2004.10.012. View

20.

Hakeam H, Breakiet M, Azzam A, Nadeem A, Amin T . The incidence of cisplatin nephrotoxicity post hyperthermic intraperitoneal chemotherapy (HIPEC) and cytoreductive surgery. Ren Fail. 2014; 36(10):1486-91. DOI: 10.3109/0886022X.2014.949758. View