Evaluating alternative protocols for preventing cisplatin-induced acute kidney injury during hyperthermic...

Cisplatin-based hyperthermic intraperitoneal chemotherapy (HIPEC) is an effective treatment to eliminate residual micrometastases and reduce recurrence after interval cytoreductive surgery for ovarian cancer. However, cisplatin is often associated with significant adverse effects, particularly acute kidney injury (AKI). This study aimed to identify factors associated with postoperative AKI and develop an alternative preventive protocol.

Patients with advanced ovarian cancer who underwent interval debulking surgery with HIPEC between April 2018 and April 2025 were included. Patients were categorized into two groups: sodium thiosulfate and hydration. AKI was defined according to KDIGO criteria, based on postoperative serum creatinine levels.

In total, 180 patients were included in the study. Of these, 90 patients received sodium thiosulfate (Ametox®) before and after surgery, whereas 90 were administered intraoperative fluid hydration containing magnesium and potassium, along with acetylcysteine and mannitol during and after surgery. In the Ametox group, 14 patients developed stage I AKI. In the hydration group, nine patients developed AKI, including six with stage I, two with stage II, and one with stage III. The incidence of AKI did not differ significantly between the two groups. Univariate and multivariate analyses identified estimated blood loss as a potential contributor to AKI occurrence (p = 0.046). Progression-free survival was similar between the two groups (p = 0.060).

The protocol utilizing fluid hydration with magnesium and potassium, combined with acetylcysteine and mannitol, was associated with a similar incidence of AKI compared with that in the case of sodium thiosulfate use, suggesting that it may be a feasible alternative.