Perioperative approach to nephrotoxicity in cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

Combining cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is a promising treatment approach for peritoneal carcinomatosis (PC). However, intraperitoneal chemotherapeutic agents significantly increase the risk of acute kidney injury (AKI). Identifying perioperative risk factors plays a critical role in preserving renal function.

To evaluate postoperative renal outcomes in patients with PC who underwent CRS + HIPEC.

Patients who underwent CRS + HIPEC for PC between 2017 and 2024 were included in this retrospective cohort study. Demographic data, preoperative estimated glomerular filtration rate, HIPEC agents used (cisplatin, mitomycin C, oxaliplatin), intraoperative fluid management, vasopressor use, and postoperative creatinine levels were recorded. AKI was defined according to the 2012 Kidney Disease: Improving Global Outcomes criteria. Independent predictors were identified through multivariate logistic regression analysis.

AKI developed in 61 of 445 patients (13.7%). Among them, 62.0% were stage I, 24.6% were stage II, and 13.1% were stage III. The highest AKI rate was observed in the cisplatin group (21.4%), with lower rates in the oxaliplatin group (9.6%) and the mitomycin C group (6.5%). Independent risk factors included cisplatin use [odds ratio (OR) = 2.8; 95% confidence interval: 1.6-4.9; P < 0.001), intraoperative fluid administration < 6000 mL (OR = 2.1; P = 0.02), vasopressor requirement (OR = 1.9; P = 0.03), and preoperative estimated glomerular filtration rate < 75 mL/minute/1.73 m² (OR = 2.3; P = 0.01). AKI was associated with a prolonged hospital stay. Three patients (0.7%) progressed to chronic kidney disease.

Independent risk factors such as cisplatin use, inadequate fluid replacement, vasopressor requirement, and preoperative renal function should be considered during perioperative planning to reduce AKI risk following CRS + HIPEC.