Perioperative approach to nephrotoxicity in cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

Table 1 Demographic data and association with acute kidney injury, n (%)

Variable	Total (N = 445)	AKI (n = 61)	No AKI (n = 384)	P value
Age (mean ± SD)	58.6 ± 11.4	62.1 ± 10.2	57.9 ± 11.6	0.021
Gender (female/male)	260/185	38/23	222/162	0.448
BMI (kg/m2)	26.1 ± 3.4	26.8 ± 3.2	26.0 ± 3.4	0.097
≥ 1 comorbidity	302 (67.8)	51 (83.6)	251 (65.3)	0.004
ASA score ≥ III	163 (36.6)	31 (50.8)	132 (34.3)	0.012
Preoperative eGFR < 75 mL/minute/1.73 m2	94 (21.1)	24 (39.3)	70 (18.2)	0.001

SD: Standard deviation, AKI: Acute kidney injury; BMI: Body mass index; ASA: American Society of Anesthesiologists; eGFR: Estimated glomerular filtration rate.

Table 2 Perioperative findings and association with acute kidney injury, n (%)

Variable	Total (N = 445)	AKI (n = 61)	No AKI (n = 384)	P value
Operation time (minutes, mean ± SD)	360 ± 75	376 ± 78	357 ± 74	0.114
Blood loss (mL, mean ± SD)	550 ± 180	590 ± 205	543 ± 176	0.198
Intraoperative fluid replacement < 6000 mL	173 (38.8)	36 (59.0)	137 (35.6)	0.001
Vasopressor use	128 (28.7)	29 (47.5)	99 (25.7)	0.002
Urine output < 0.5 mL/kg/hour	84 (18.8)	19 (31.1)	65 (16.9)	0.009

AKI: Acute kidney injury; SD: Standard deviation.

Table 3 Nephrotoxicity data and distribution by chemotherapy agent, n (%)

Variable	Total (N = 445)	Cisplatin (n = 126)	Other agents (n = 319)	P value
AKI incidence	61 (13.7)	27 (21.4)	34 (10.6)	0.005
AKI stage 1/2/3	38/15/8	18/6/3	20/9/5	0.839
Development of CKD	5 (1.1)	3 (2.4)	2 (0.6)	0.154

AKI: Acute kidney injury; CKD: Chronic kidney disease.

Table 4 Acute kidney injury rates by hyperthermic intraperitoneal chemotherapy agents

HIPEC agent	Total patients	AKI cases	AKI rate (%)	P value
Cisplatin	126	34	26.90
Oxaliplatin	155	14	9.10
Mitomycin C	164	13	7.80
Total	445	61		0.0008

HIPEC: Hyperthermic intraperitoneal chemotherapy; AKI: Acute kidney injury.