Abstract

Background

Acute renal impairment (ARI) is a major complication after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) for cancer patients with peritoneal metastases. This study aimed to investigate the incidence and identify the risk factors of post-HIPEC creatinine increased.

Methods

From April 2015 to December 2019, demographic and perioperative data of 169 patients undergoing CRS/HIPEC with a preoperative creatinine level <1.5 mg/dL were retrospectively reviewed. Renal impairment was defined according to the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE) version 5.0. The risk factors of creatinine increased were analyzed using univariate and multiple logistic regression analyses.

Results

Among the 169 enrolled patients, 21 (12.4%) had postoperative creatinine increased (ARI group) and 148 (87.6%) did not (non-ARI group). Significantly more of the ARI group received a cisplatin HIPEC regimen than the non-ARI group (71.4 vs. 37.8%, p = 0.004). Multiple logistic regression analysis revealed that the patients who received a cisplatin HIPEC regimen (adjusted odds ratio [AOR] = 11.38, p < 0.001) and peritoneal dialysis solution as HIPEC perfusate (AOR = 7.07, p = 0.002) were more likely to develop post-HIPEC creatinine increased.

Conclusions

Identifying the risk factors of post-HIPEC creatinine increased can help to improve patient selection, a dose of HIPEC regimens modification and perioperative care. We also identified the detrimental renal effect of peritoneal dialysis solution as HIPEC perfusate. More prospective studies are warranted to confirm these findings.

中文翻译：

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细胞减灭术和腹腔热化疗后急性肾功能不全的危险因素

摘要

背景

对于患有腹膜转移癌的癌症患者，急性肾功能不全（ARI）是细胞减灭术和腹膜内高温化疗（CRS / HIPEC）后的主要并发症。本研究旨在调查HIPEC后肌酐升高的发生率并确定危险因素。

方法

从2015年4月至2019年12月，回顾性分析了169例接受CRS / HIPEC且术前肌酐水平<1.5 mg / dL的患者的围手术期数据。根据美国国家癌症研究所不良事件通用术语标准（NCI-CTCAE）5.0版定义肾功能损害。肌酐升高的危险因素采用单因素和多元logistic回归分析。

结果

在169例入组患者中，有21例（12.4％）术后肌酐升高（ARI组），而148例（87.6％）没有（非ARI组）。与非ARI组相比，ARI组接受顺铂HIPEC方案的比例明显更高（71.4 vs. 37.8％，p  = 0.004）。多元逻辑回归分析显示，接受顺铂HIPEC方案（校正比值比[AOR] = 11.38，p  <0.001）和腹膜透析液作为HIPEC灌流液（AOR = 7.07，p  = 0.002）的患者更容易在术后-HIPEC肌酐增加。

结论

确定HIPEC后肌酐升高的危险因素可以帮助改善患者选择，一定剂量的HIPEC方案修改和围手术期护理。我们还确定了腹膜透析液对肾脏的有害作用为HIPEC灌流液。有必要进行更多的前瞻性研究来证实这些发现。