Acute kidney injury in ovarian cancer patients undergoing cytoreductive surgery and hyperthermic intra-peritoneal chemotherapy

Figures & data

Table 1. Patient demographics and clinical characteristics.

Variable	Median (Range)	Number (%)
Total number of patients		47 (100)
Age at surgery, years	50 (24–74)
Baseline creatinine, μmol/L	53 (28–102)
Pre-op albumin, g/L	39 (13–45)
Pre-op carboplatin
No		12 (25.5)
Yes		35 (74.5)
No. of cycles of pre-op carboplatin	6 (0–22)
Pre-op cisplatin
No		41 (87.2)
Yes		6 (12.8)
No. of cycles of pre-op cisplatin  (for patients who received it)	1 (1–6)
Pre-op paclitaxel
No		10 (21.3)
Yes		37 (78.7)
No. of cycles of pre-op paclitaxel	6 (0–18)
Time interval between pre-op  chemo and op, days	15 (7–60)
Estimated blood loss intra-op, L	1.40 (0.10–5.10)
Unknown		1 (2.1)
Duration of CRS – HIPEC	500 (230–920)
Number of operative procedures	2 (1–4)
Types of procedures
THBSO		17 (36.1)
Colectomy		9 (19.1)
Small bowel resection		18 (38.2)
Splenectomy		8 (17.0)
Gastrectomy		3 (6.4)
Cholecystectomy		12 (25.5)
Diaphragmatic peritonectomy		8 (17.0)
Unknown		5 (10.6)
Cisplatin dose during HIPEC  (at a fixed dose of 90mg/m^2), mg	64 (40–81)
<70^a		27 (57.4)
≥70		20 (42.6)
Temperature of HIPEC,°C		40 (40–41.5)
Post-op blood transfusion
No (0 pints)		16 (34.0)
Yes (> 0 pints)		31 (66.0)
Post-op blood transfusion, pints	1 (0–17)
Post-op carboplatin
No		30 (63.8)
Yes		16 (34.0)
Unknown		1 (2.1)
No. of cycles of post-op carboplatin	0 (0–8)
Unknown		1 (2.1)
Post-op cisplatin
No		42 (89.4)
Yes		5 (10.6)
No. of cycles of post-op cisplatin	0 (0–8)
Post-op paclitaxel
No		41 (87.2)
Yes		5 (10.6)
Unknown		1 (2.1)
No. of cycles of post-op paclitaxel	0 (0–6)
Unknown		1 (2.1)
EPIC
No		23 (48.9)
Yes		24 (51.1)
Duration of EPIC, days	0.5 (0–6)
Unknown		1 (2.1)
AKI post-op
No		28 (59.6)
Yes		19 (40.4)
Long-term renal impairment  (amongst patients who had AKI post-op)
No		11 (57.9)
Yes		7 (36.8)
Unknown		1 (5.3)

^a Cut-off identified from recursive partitioning analysis.

Table 2. Characteristics of patients who developed AKI.

	Total no. of patients who had AKI =19
Variable name	Grade <3 (N = 14)	Grade 3 (N = 2)	Grade 4 (N = 3)
Max Cr	133.5 (101–248)	373, 404	543, 780, 922
Max U	10.6 (9–33)	12.2, 15.4	22, 26.4, 26.5
Day of onset	3 (0–6)	1, 2	1, 1, 2
Day of max Cr	5.5 (1–9)	6, 19	8, 13, 16
Days to recovery  of renal fxn	5 (2–120)	All did not recover	All did not recover

Table 3. Univariate analysis of dichotomised risk factors for AKI.

	Acute kidney injury
	Number of patients (%)
Characteristic(N = 47)	No (N = 28)	Yes (N = 19)	p Value^a	Odds ratio(95%CI)	p Value^b
Age at surgery, years			.026		.023
≤48	15 (53.6)	4 (21.1)		1
>48	13 (46.4)	15 (78.9)		4.33 (1.14–16.36)
Baseline creatinine, μmol/L			.002		.002
≤61	25 (89.3)	9 (47.4)		1
>61	3 (10.7)	10 (52.6)		9.26 (2.07–41.43)
Baseline eGFR (Cockcroft–Gault), mL/min			.015		.014
>80.2	16 (57.1)	4 (21.1)		1
≤80.2	8 (28.6)	11 (57.9)		5.50 (1.32–22.86)
Missing (no weight)	4 (14.3)	4 (21.1)
Baseline eGFR (MDRD), mL/min			.002		.002
>90	25 (89.3)	9 (47.4)		1
≤90	3 (10.7)	10 (52.6)		9.26 (2.07–41.43)
Pre-op carboplatin			.737		.559
No	8 (28.6)	4 (21.1)		1
Yes	20 (71.4)	15 (78.9)		1.5 (0.38–5.93)
No. of cycles of pre-op carboplatin			.047		.029
None or ≤8	26 (92.9)	13 (68.4)		1
>8	2 (7.1)	6 (31.6)		6.00 (1.06–33.95)
Pre-op cisplatin			.674		.612
No	25 (89.3)	16 (84.2)		1
Yes	3 (10.7)	3 (15.8)		1.56 (0.28–8.72)
No. of cycles of pre-op cisplatin^d	0 (0–6)^c	0 (0–6)^c	.562	1.21 (0.77–1.90)	.387
Pre-op paclitaxel			1.000		.975
No	6 (21.4)	4 (21.1)		1
Yes	22 (78.6)	15 (79.0)		1.02 (0.25–4.25)
No. of cycles of pre-op paclitaxel			.453		.308
None or ≤6	24 (85.7)	14 (73.7)		1
>6	4 (14.3)	5 (26.3)		2.14 (0.49–9.33)
Time interval between pre-op chemo and op, days			.033		.021
>7 or no pre-op chemo	27 (96.4)	14 (73.7)		1
≤7	1 (3.6)	5 (26.3)		9.64 (1.02–90.76)
Estimated intra-op blood loss, mL			.107		.080
>450	25 (89.3)	14 (73.7)		1
≤450	2 (7.1)	5 (26.3)		4.46 (0.76–26.09)
Missing	1 (3.6)	0 (0)
Cisplatin dose during HIPEC, mg
Median (Range)	60
(40–80)	70
(40–81)	.848	1.00 (0.94–1.07)	.913
<70	18 (64.2)	9 (47.4)	.692	1	.410
≥70	10 (35.7)	10 (52.6)		2.25 (0.33–13.33)
Post-op blood transfusion, pints			.018		.013
None or ≤2	25 (89.3)	11 (57.9)		1
> 2	3 (10.7)	8 (42.1)		6.06 (1.35–27.28)
EPIC			.312		.311
No	12 (42.9)	11 (57.9)		1
Yes	16 (57.1)	8 (42.1)		0.55 (0.17–1.77)
Duration of EPIC, days (denominator = patients who received EPIC – 24)			.039		.034
≤3	3 (12.5)	2 (8.3)		1
>3	14 (58.3)	4 (16.6)		0.28 (0.10–0.94)
Missing	1 (4.2)	0 (0)

All cut-off points for continuous variables were determined using recursive partitioning analysis. Underlined p values achieved statistical significance.

^a Pearson’s chi-squared or Fisher’s exact test. Mann–Whitney U test for no. of cycles of pre-op cisplatin.

^b Likelihood-ratio test of logistic regression model.

^c Median and range presented for no. of cycles of pre-op cisplatin.

^d As no cut-off point could be identified for no. of cycles of pre-op cisplatin, it was analysed as a continuous variable.