The incidence of cisplatin nephrotoxicity post hyperthermic intraperitoneal chemotherapy (HIPEC) and cytoreductive surgery

Figures & data

Table 1. RIFLE classification for acute kidney injury.15.

Category	GFR criteria	UO criteria
Risk (R)	Increased creatinine level × 1.5 or GFR decrease > 25%	UO < 0.5 mL/kg/h × 6 h
Injury (I)	Increased creatinine level × 2 or GFR decrease > 50%	UO < 0.5 mL/kg/h × 12 h
Failure (F)	Increased creatinine level × 3 or GFR decrease > 75% or creatinine level > 4 mg/dL	UO < 0.3 mL/kg/h × 24 h or anuria × 12 h
Loss (L)	Persistent acute renal failure or complete loss of renal function for > 4 weeks
ESRD (E)	ESRD for > 3 months

Notes: GFR: glomerular filtration rate; UO: urine output; ESRD: end-stage renal disease.

Table 2. Demographic data and clinical characteristics for patients with NRIF (no renal failure, injury or risk) versus RIF (renal failure, injury or risk) according to RIFLE classification.

	All patients n = 53	Patients with RIF n = 2	Patients with NRIF n = 51	p Value
Female, %	50 (94.3%)	2 (100%)	48 (94.1%)
Age (years)	49.6 ± 11.1	49.79 ± 11	46 ± 8.4	0.64
Weight (kg)	74.9 ± 14.7	98.1 ± 29	70.3 ± 19	0.01
BSA (m^2)	1.78 ± 0.19	2.06 ± 0.4	1.77 ± 1.8	0.046
Co morbidities
Diabetes mellitus	14 (26.4%)	1 (50%)	13 (25.4%)	0.42
Hypertension	11 (20.7%)	2 (100%)	9 (17.6%)	0.049
CKD	2 (3.7%)	0 (0%)	2 (3.9%)	0.92
Medications
ACE-I	9 (16.9 %)	0(0%)	9 (17.6%)	0.36
ARB	3 (5.6%)	2 (100%)	2 (3.9%)	0.004
NSAIDs	8 (15%)	0 (0%)	8 (15.6%)	0
Vancomycin	25 (47.1 %)	1 (50%)	24 (47%)	0.72
Aminoglycosides	0 (0%)	0%	0%	0
Contrast media	20 (37.7%)	1 (50%)	19 (37.2%)	0.78
Laboratory data
CFR (mL/min/1.73 m^2)	78 ± 1	80 ± 8	77 ± 11	0.1
Intraoperative data
Operating time (h)	11 ± 1.9	10	10.75	0.89
Fluid Balance (L)	9.2 ± 3.9	8.8	9.6	0.09
Albumin 5% (L)	1.9 ± 0.9	2	1.9	0.1
Urine output (mL/h)	358 ± 195	225	364	< 0.02
Vasopressor (n, %)	25 (47.1%)	1	24	0.87

Notes: BSA: body surface area; CKD: chronic kidney diseases; ACE-I: angiotensin converting enzyme inhibitors; ARB: angiotensin II receptor blockers; NSAIDs: non-steroidal anti-inflammatory drugs; and GFR: glomerular filtration rate calculated using MDRD formula.

Table 3. Outcomes of two patients with RIF (renal failure, injury or risk).

Characteristics	Patient A	Patient B	Compared to NRIF P
Nephrotoxicity
RIFLE classification	F	I	Not applicable
Onset (number of days post cisplatin)	6	4	Not applicable
Peak SrCr (mmol/L)	382	101	Not applicable
Time to SrCr peak (days)^a	9	5	Not Applicable
Recovery from AKI (days)^a	14	8	Not applicable
Normalization of SrCr (days)^a	Never	8	Not applicable
Nephrotoxic medications	Vancomycin^b Losartan	Losartan	0.004 for losartan
Intravenous contrast media	Yes	No	NS
Baseline serum magnesium level (mmol/L)	0.73	0.66	NS
Intraoperative data
Urine output (mL/h)	250	200	< 0.025
Fluid balance (L)	11.1	6	NS
Blood loss (L)	0.8	1.8	NS
Vasopressors	no	yes	NS
Albumin (L)	2.5	1.5	NS

Notes: SrCr: serum creatinine; AKI: acute kidney injury; NRIF: no renal failure, injury or risk, based on RIFLE classification; and NS: Non significant.

^aPost cisplatin use with HIPEC.

^bVancomycin trough levels were obtained twice prior to kidney insult 6.1 mg/L on day 2 of vancomycin treatment and 10.5 mg/L on day 4 of vancomycin treatment.

Table 4. Mean serum biochemistries at baseline with comparison at day 3, day 7 and day 30 post-HIPEC using cisplatin.

	Creatinine (mean ± SD) mmol/L	Urea (mean ± SD) mmol/L	Magnesium (mean ± SD) mmol/L	Albumin (mean ± SD) mg/L
Baseline	59.9 ± 13.3	3.7 ± 0.9	0.79 ± 0.07	39 ± 2.8
Day 3 post	43.5 ± 12^a	3.4 ± 1.3^a	0.74 ± 0.14^a	32.3 ± 5.7^a
HIPEC	p < 0.001	p < 0.05	p < 0.01	p < 0.01
Day 7 Post	49.7 ± 16.5^b	5.06 ± 2.5^b	0.77 ± 0.11^b	34.3 ± 4.2^b
HIPEC	p = 0.004	p < 0.01	p < 0.02	p < 0.01
Day 30 Post	58.3 ± 21.1^c	3.6 ± 1.4^c	0.69 ± 0.09^c	36.4 ± 7.2^c
HIPEC	p = 0.4	p > 0.1	p < 0.001	p < 0.025

Notes: ^ap Value for mean baseline versus day 3 post-HIPEC using student t-test.

^bp Value for mean baseline versus day 7 post-HIPEC using student t-test.

^cp Value for mean baseline versus day 30 post-HIPEC using student t-test.

Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P. Acute renal failure – Definition, outcome measures, animal models, fluid therapy and information technology needs: The Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care. 2004;8(4):R204–R212

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