Acute kidney injury in ovarian cancer patients undergoing cytoreductive surgery and hyperthermic intra-peritoneal chemotherapy. (18th August 2017)

• Record Type: Journal Article
• Authors: Sin, Eliza I-Lin; Chia, Claramae Shulyn; Tan, Grace Hwei Ching; Soo, Khee Chee; Teo, Melissa Ching-Ching
• Is Part Of: International journal of hyperthermia. Volume 33:Number 6(2017)
• Page Start: 690
• Page End: 695
• Publication Date: 2017-08-18
• Subjects: Acute kidney injury -- cytoreductive surgery -- cisplatin -- intra-peritoneal chemotherapy; Thermotherapy -- Periodicals; 615.832
• DOI: 10.1080/02656736.2017.1293304
• Languages: English
• ISSNs: 0265-6736

Abstract

Abstract: Background: Cytoreductive surgery and hyperthermic intra-peritoneal chemotherapy (CRS-HIPEC) prolongs survival in patients with metastatic peritoneal disease. We look at the incidence of acute kidney injury (AKI) in patients who have received cisplatin during CRS-HIPEC in the treatment of peritoneal carcinomatosis from an ovarian primary, and identify possible peri-operative risk factors. Methods: Between 2005 and 2013, we performed CRS-HIPEC on 47 patients with ovarian primaries and peritoneal metastasis. Retrospective data were collected on the patient's demographics, treatment details and outcomes. Renal impairment was graded according to the NCI-CTCAE 3.0 criteria. Results: There were 47 patients, with a median age of 50 (24–74) years. The median baseline creatinine was 53 μmol/L (23–102) and median baseline albumin of 39 g/L (13–45). All underwent pre-operative chemotherapy for a median of six cycles (0–22) with a median of 15 days between chemotherapy and surgery. They received intra-operative cisplatin at a temperature of 40 °C for 60 min at a median dose of 90 mg/kg. 19 (40.4%) experienced post-operative AKI, of which 5 (8.5%) developed grade 3 and 4 impairment. Two (4.3%) required long-term dialysis. Univariate analysis showed that risk factors for AKI included age, baseline creatinine, baseline estimated glomerular filtration rate, pre-operative albumin, number of cycles of pre-operative carboplatin, time interval between pre-operative chemotherapy and CRS-HIPEC and volume of blood transfusions. Conclusions: Identification of risk factors for AKI post-CRS-HIPEC helps improve pre-operative patient selection and optimisation, facilitate tailoring of chemotherapy, and foster closer peri-operative monitoring and fluid management in at-risk patients.