Cheng Chih-Chung, Yeh Hung-Chieh, Su Pei-Wen, Ho Chien-Lin, Chang Sheng-Chi
Department of Surgery, China Medical University Hospital, Taichung, Taiwan.
Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.
Int J Hyperthermia. 2024;41(1):2304250. doi: 10.1080/02656736.2024.2304250. Epub 2024 Feb 11.
Cisplatin is commonly prescribed in hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal malignancy. Acute kidney injury (AKI) is regarded as a common complication after HIPEC combined with cytoreductive surgery (CRS). However, post-HIPEC chronic kidney disease (CKD) is scarce and less investigated. This study aims to investigate the incidence of CKD following cisplatin-based HIPEC and to analyse the associated risk factors.
From January 2016 to August 2021, a total of 55 patients treated with CRS and cisplatin-based HIPEC for peritoneal carcinomatosis were categorized retrospectively into groups, with and without CKD. Demographics, comorbidity, surgery, postoperative management, and complications were collected to evaluate risk factors for cisplatin-based HIPEC-related CKD. Univariate and multivariate analyses were conducted to confirm the correlation between different variables and CKD occurrence.
Of the 55 patients, 24 (43.6%) patients developed AKI and 17 (70.8%) patients of these AKI patients progressed to CKD. Multivariate regression analysis identified intraoperative use of parecoxib (Odds Ratio (OR) = 4.39) and intraoperative maximum temperature > 38.5°C (OR = 6.40) as major risk factors for cisplatin-based HIPEC-related CKD occurrence. Though type II diabetes mellitus and intraoperative complications were the independent risk factors of AKI following cisplatin-based HIPEC, but they were not shown in CKD analysis.
Intraoperative use of parecoxib during cisplatin-based HIPEC emerged as a significant risk factor for postoperative CKD. Clinicians should exercise caution in prescribing parecoxib during HIPEC procedures. Additionally, maintaining intraoperative body temperature below 38.5°C might be crucial to mitigate the risk of CKD development. This study underscores the importance of identifying and preventing specific risk factors to improve long-term renal outcomes in patients undergoing cisplatin-based HIPEC.
顺铂常用于腹腔热灌注化疗（HIPEC）治疗腹膜恶性肿瘤。急性肾损伤（AKI）被认为是HIPEC联合细胞减灭术（CRS）后的常见并发症。然而，HIPEC后慢性肾脏病（CKD）较为少见且研究较少。本研究旨在调查基于顺铂的HIPEC后CKD的发生率，并分析相关危险因素。
回顾性分析2016年1月至2021年8月期间共55例接受CRS及基于顺铂的HIPEC治疗腹膜癌病的患者，将其分为有CKD组和无CKD组。收集人口统计学资料、合并症、手术情况、术后管理及并发症等，以评估基于顺铂的HIPEC相关CKD的危险因素。进行单因素和多因素分析以确认不同变量与CKD发生之间的相关性。
55例患者中，24例（43.6%）发生AKI，其中17例（70.8%）AKI患者进展为CKD。多因素回归分析确定术中使用帕瑞昔布（比值比（OR）=4.39）和术中最高体温>38.5°C（OR = 6.40）是基于顺铂的HIPEC相关CKD发生的主要危险因素。虽然II型糖尿病和术中并发症是基于顺铂的HIPEC后AKI的独立危险因素，但在CKD分析中未显示。
基于顺铂的HIPEC术中使用帕瑞昔布是术后CKD的一个重要危险因素。临床医生在HIPEC手术中开具帕瑞昔布时应谨慎。此外，将术中体温维持在38.5°C以下可能对降低CKD发生风险至关重要。本研究强调了识别和预防特定危险因素以改善接受基于顺铂的HIPEC患者长期肾脏结局的重要性。
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