Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chiayi, Taiwan.
Peritoneal Malignancy Program of Cancer Center, Chang-Gung Memorial Hospital, Chiayi, Taiwan.
Int J Hyperthermia. 2020;37(1):1279-1286. doi: 10.1080/02656736.2020.1846793.
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.
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.
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%, = 0.004). Multiple logistic regression analysis revealed that the patients who received a cisplatin HIPEC regimen (adjusted odds ratio [AOR] = 11.38, < 0.001) and peritoneal dialysis solution as HIPEC perfusate (AOR = 7.07, = 0.002) were more likely to develop post-HIPEC creatinine increased.
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.
急性肾损伤（ARI）是癌症合并腹膜转移患者行细胞减灭术和腹腔热灌注化疗（CRS/HIPEC）后的主要并发症。本研究旨在探讨 HIPEC 术后肌酐升高的发生率，并确定其危险因素。
回顾性分析 2015 年 4 月至 2019 年 12 月期间 169 例行 CRS/HIPEC 术且术前肌酐水平<1.5mg/dL 的患者的人口统计学和围手术期数据。根据美国国立癌症研究所不良事件通用术语标准（NCI-CTCAE）第 5.0 版定义肾功能损伤。采用单因素和多因素逻辑回归分析评估肌酐升高的危险因素。
在纳入的 169 例患者中，21 例（12.4%）术后出现肌酐升高（ARI 组），148 例（87.6%）未升高（非 ARI 组）。ARI 组接受顺铂 HIPEC 方案的比例明显高于非 ARI 组（71.4% vs. 37.8%， = 0.004）。多因素逻辑回归分析显示，接受顺铂 HIPEC 方案（调整优势比 [AOR] = 11.38， < 0.001）和以腹膜透析液作为 HIPEC 灌注液（AOR = 7.07， = 0.002）的患者更有可能发生 HIPEC 术后肌酐升高。
确定 HIPEC 术后肌酐升高的危险因素有助于改善患者选择、HIPEC 方案剂量调整和围手术期管理。我们还发现腹膜透析液作为 HIPEC 灌注液对肾脏有不良影响。需要更多的前瞻性研究来证实这些发现。
