Prophylactic sodium thiosulfate reduces the risk and severity of acute kidney injury in oxaliplatin-based hyperthermic intraperitoneal chemotherapy

doi:10.4251/wjgo.v18.i7.118400

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World Journal of Gastrointestinal Oncology

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1948-5204

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastrointest Oncol. Jul 15, 2026; 18(7): 118400
Published online Jul 15, 2026. doi: 10.4251/wjgo.v18.i7.118400

Table 1 Patient characteristics, including preoperative kidney function, stratified on perioperative treatment with prophylactic sodium thiosulfate or no sodium thiosulfate, n (%)

Variable	nST (n = 73)	ST (n = 46)	P value
Age			0.73¹
≤ 59	31 (42)	21 (46)
> 59	42 (58)	25 (54)
Sex			0.50¹
Male	38 (52)	21 (46)
Female	35 (48)	25 (54)
PCI score
0-8	36 (49)	31 (67)	Reference
9-15	21 (29)	10 (22)	0.19²
> 15	16 (22)	5 (11)	0.07
Baseline creatinine: Median; IQR	68 (62-80)	69 (59-76)	0.60³
Baseline eGFR: Median; IQR	77 (67-86)	76 (64-87)	0.94³
Preoperative kidney function⁴^,⁵
G1	14 (20.3)	11 (24.4)	Reference
G2	45 (65.2)	29 (64.4)	0.67²
G3a	9 (13)	3 (6.7)	0.27
G3b	1 (1.4)	2 (4.4)	0.47
Preoperative comorbidities
BMI ≥ 30	20 (27)	10 (22)	0.49¹
Smoking	7 (10)	5 (11)	0.82
Diabetes mellitus	10 (14)	8 (17)	0.58
Diabetes mellitus - insulin	8 (11)	1 (2)	0.20
Cardiovascular disease	9 (12)	6 (13)	0.91
Hypertension	22 (30)	18 (39)	0.31
ASA
1	28 (38)	20 (44)	Reference
2	32 (44)	19 (41)	0.65²
3	13 (18)	7 (15)	0.61

¹χ² test.

²Binary logistic regression analysis.

³Mann-Whittney U test.

⁴According to Kidney Disease: Improving Global Outcomes classification of estimated glomerular filtration rate.

⁵Missing in 5 patients.

nST: No sodium thiosulfate; ST: Sodium thiosulfate; PCI: Peritoneal carcinomatosis index; IQR: Interquartile range; eGFR: Estimated glomerular filtration rate; BMI: Body mass index; ASA: American Society of Anesthesiologists.

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Table 2 Perioperative characteristics, stratified on perioperative treatment with prophylactic sodium thiosulfate or no sodium thiosulfate, n (%)

Variable	nST (n = 73)	ST (n = 46)	P value
Reduced dose of intraperitoneal chemotherapy
No	41 (56)	41 (89)	< 0.001¹
Yes	32 (44)	5 (11)	< 0.001¹
Length of operation	601 (523-690)	413 (351-488)	< 0.001²
Intraoperative bleeding	600 (350-800)	700 (413-1000)	0.12²
Intraoperative hypotension⁴: Minutes⁵
0	40 (55)	22 (49)	Reference
< 0 - < 7.12	11 (15)	4 (9)	0.52³
≥ 7.12	22 (30)	19 (42)	0.27
Inotropic support⁶
≤ 32 hours	44 (64)	28 (61)	0.75¹
> 32 hours	25 (36)	18 (39)	0.75¹
Peak postoperative lactate median; (IQR)	2.7 (2.2-3.1)	1.9 (1.6-2.4)	< 0.001²
GI anastomosis
0	31 (42)	16 (35)	Reference
1	32 (44)	25 (54)	0.31³
2	5 (7)	4 (9)	0.55
> 2	5 (7)	1 (2)	0.41
Stoma formation
No	33 (45)	28 (61)	Reference
Yes	38 (52)	15 (33)	0.06³
Has prior to surgery	2 (3)	3 (6)	0.55

¹χ² test.

²Mann-Whittney U test.

³Binary logistic regression analysis.

⁴< 80 mmHg.

⁵One missing patient.

⁶Four missing patients.

nST: No sodium thiosulfate; ST: Sodium thiosulfate; IQR: Interquartile range.

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Table 3 Postoperative serum creatinine and acute kidney injury stratified by prophylactic sodium thiosulfate

Variable	nST (n = 73)	ST (n = 46)	P value	OR (95%CI)
Peak postop creatinine median; (IQR)	114 (97-146)	92 (76-112)	< 0.001¹	N/A
Max relative increase in creatinine percentage median; (IQR)	63 (45-111)	40 (26-53)	< 0.001¹	N/A
Post op AKI	48 (66)	13 (28)	< 0.001²	0.21 (0.09-0.46)
Grade of AKI
No AKI	25 (34.2)	33 (71.7)	Reference	-
Grade 1	28 (38.4)	10 (21.7)	0.004²	0.27 (0.11-0.66)
Grade 2	17 (23.3)	3 (6.5)	0.003²	0.13 (0.04-0.51)
Grade 3	3 (4.1)	0 (0)	N/A³	N/A³

¹Mann-Whittney test.

²χ² test.

³Too few cases to be calculated.

nST: No sodium thiosulfate; ST: Sodium thiosulfate; AKI: Acute kidney injury; CI: Confidence interval; OR: Odds ratio; N/A: Not applicable; IQR: Interquartile range.

Full Size Table

Table 4 Adjusted risk analysis of postoperative acute kidney injury, estimated by logistic regression

Variable	No AKI (n = 58)	AKI (n = 61)	Univariate analysis		Multivariate analysis
Variable	No AKI (n = 58)	AKI (n = 61)	P value	OR (95%CI)	P value	OR (95%CI)
Sodium thiosulfate					< 0.001	0.10 (0.03-0.38)
No	25	48	Reference	-
Yes	33	13	< 0.001	0.21 (0.09-0.46)
Age					0.70	1.19 (0.46-3.24)
≤ 59	25	27	-	Reference
> 59	33	34	0.90	0.95 (0.46-1.97)
Sex					-	-
Male	29	30	Reference	-
Female	29	31	0.93	1.03 (0.50-2.12)
Cardiovascular comorbidities¹
0	24	25	Reference	-	-	-
1	16	21	0.60	1.26 (0.53-2.97)	0.37	1.68 (0.54-5.23)
≥ 2	18	15	0.62	0.80 (0.33-1.94)	0.90	0.93 (0.30-2.90)
ASA classification
1	23	25	Reference	-	-	-
2	26	25	0.76	0.89 (0.40-1.95)
3	9	11	0.83	1.12 (0.39-3.20)
Reduced IP dose
No	40	42	Reference	-	-	-
Yes	18	19	0.99	1.01 (0.46-2.19)	0.13	0.41 (0.13-1.28)
Neoadjuvant chemo
No	43	49	Reference	-	-	-
Yes	15	12	0.42	0.70 (0.30-1.66)	-	-
Chemotherapy naive
No	33	36	Reference	-	-	-
Yes	25	25	0.82	0.92 (0.44-1.90)
Operation time
≤ 537 minutes	39	21	Reference	-	-	-
> 537 minutes	19	40	< 0.001	3.91 (1.83-8.37)	0.22	1.99 (0.67-5.96)
Intraoperative bleeding
≤ 600 mL	35	30	Reference	1.57 (0.76-3.25)	0.10	2.26 (0.86-5.94)
> 600 mL	23	31	0.22	1.57 (0.76-3.25)	0.10	2.26 (0.86-5.94)
Intraoperative hypotension (minute)³
None	34	28	Reference	-	-	-
0-7.12	8	7	0.92	1.06 (0.34-3.29)	0.51	0.60 (0.13-2.74)
> 7.12	15	26	0.07	2.11 (0.94-4.73)	0.06	2.82 (0.98-8.16)
Peak lactic acid level
< 2.4	34	28	Reference	-	-	-
≥ 2.4	24	33	0.17	1.67 (0.81-3.45)	0.92	0.95 (0.34-2.64)
Postoperative inotropy⁴
≤ 32 hours	35	37	Reference	-	-	-
> 32 hours	21	22	0.98	0.99 (0.47-2.11)	0.55	0.75 (0.28-1.97)
Complications
No complication	31	28	Reference	-	-	0.40 (0.13-1.19)
< 3b	24	22	0.97	1.02 (0.47-2.20)	0.10	-
≥ 3b	3	11	0.05	4.06 (1.03-16.1)	0.13	4.43 (0.64-30.5)
Sepsis with AKI	0	4	0.05	N/A²	-	-

¹Diabetes mellitus, hypertension, smoking, body mass index ≥ 30, history of myocardial infarction or peripheral arterial insufficiency.

²Too few cases to be calculated.

³One missing patient.

⁴Four missing patients.

AKI: Acute kidney injury; CI: Confidence interval; OR: Odds ratio; N/A: Not applicable; ASA: American Society of Anesthesiologists; IP: Intraperitoneal chemotherapy.

Full Size Table

Table 5 Adjusted risk analysis of postoperative complications (except acute kidney injury) estimated by logistic regression

Variable	No complications (n = 59)	Complications (n = 60)	Univariate analysis		Multivariate analysis
Variable	No complications (n = 59)	Complications (n = 60)	P value	OR (95%CI)	P value	OR (95%CI)
Sodium thiosulfate
No	28	45	Reference	-	-	-
Yes	31	15	0.002	0.30 (0.14-0.65)	0.29	0.56 (0.19-1.64)
Age
≤ 59	26	26	Reference	-	0.91	0.95 (0.39-2.30)
> 59	33	34	0.94	1.03 (0.50-2.13)	-	-
Sex
Male	26	33	Reference	-	-	-
Female	33	27	0.23	0.66 (0.31-1.33)	-	-
Cardiovascular comorbidities¹
0	27	22	Reference	-	-	-
1	15	22	0.18	1.80 (0.76-4.27)	0.38	1.56 (0.57-4.26)
≥ 2	17	16	0.75	1.16 (0.48-2.80)	0.52	1.42 (0.49-4.16)
ASA classification
1	26	22	Reference	-	-	-
2	24	27	0.48	1.33 (0.60-2.93)
3	9	11	0.49	1.44 (0.51-4.12)
Reduced IP dose
No	42	40	Reference	-	-	-
Yes	17	20	0.6	1.24 (0.57-2.69)	0.6	0.77 (0.29-2.06)
Neoadjuvant chemotherapy
No	49	43	Reference	-	-	-
Yes	10	17	0.14	1.94 (0.80-4.68)	-	-
Chemotherapy naive
No	35	34	Reference	-	-	-
Yes	24	26	0.77	1.12 (0.54-2.31)	-	-
Operating time
≤ 537 minutes	41	19	Reference	-	-	-
> 537 minutes	18	41	< 0.001	4.92 (2.26-10.7)	0.005	4.09 (1.54-10.8)
Bleeding
≤ 600 mL	33	32	Reference	-	-	-
> 600 mL	26	28	0.78	1.11 (0.54-2.29)	0.82	0.90 (0.37-2.22)
Intraoperative hypotension (minute)
None	32	30	Reference	1.60 (0.51-5.04)	0.83	1.16 (0.31-4.36)
0-7.12	6	9	0.42	1.01 (0.46-2.24)	0.96	0.97 (0.38-2.45)
> 7.12	21	20	0.97	-	-	-
Peak lactic acid level
< 2.4	37	25	Reference	2.36 (1.13-4.92)	0.49	1.38 (0.55-3.43)
≥ 2.4	22	35	0.02	2.36 (1.13-4.92)	0.49	1.38 (0.55-3.43)
Postoperative inotropy
≤ 32 hours	36	36	Reference	-	-	-
> 32 hours	22	21	0.98	0.96 (0.45-2.03)	0.76	0.87 (0.36-2.10)

¹Diabetes mellitus, hypertension, smoking, body mass index ≥ 30, history of myocardial infarction or peripheral arterial insufficiency.

CI: Confidence interval; OR: Odds ratio; ASA: American Society of Anesthesiologists; IP: Intraperitoneal chemotherapy.

Full Size Table

Citation: Algethami N, Valdimarsson V, Verwaal V, Syk I. Prophylactic sodium thiosulfate reduces the risk and severity of acute kidney injury in oxaliplatin-based hyperthermic intraperitoneal chemotherapy. World J Gastrointest Oncol 2026; 18(7): 118400
URL: https://www.wjgnet.com/1948-5204/full/v18/i7/118400.htm
DOI: https://dx.doi.org/10.4251/wjgo.v18.i7.118400

Algethami N, Valdimarsson V, Verwaal V, Syk I. Prophylactic sodium thiosulfate reduces the risk and severity of acute kidney injury in oxaliplatin-based hyperthermic intraperitoneal chemotherapy. World J Gastrointest Oncol 2026; 18(7): 118400 [DOI: 10.4251/wjgo.v18.i7.118400]

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