Sodium Thiosulfate Reduces Acute Kidney Injury in Patients Undergoing Cytoreductive Surgery Plus Hyperthermic Intraperitoneal Chemotherapy with Cisplatin: A Single-Center Observational Study

Annika Kurreck, Felix Gronau, Miguel Enrique Alberto Vilchez, Wiltrud Abels, Philipp Enghard, Andreas Brandl, Roland Francis, Bettina Föhre, Christian Lojewski, Johann Pratschke, Peter Thuss-Patience, Dominik Modest, Beate Rau, Linda Feldbrügge, Annika Kurreck, Felix Gronau, Miguel Enrique Alberto Vilchez, Wiltrud Abels, Philipp Enghard, Andreas Brandl, Roland Francis, Bettina Föhre, Christian Lojewski, Johann Pratschke, Peter Thuss-Patience, Dominik Modest, Beate Rau, Linda Feldbrügge

Abstract

Background: Cytoreductive surgery (CRS) in combination with hyperthermic intraperitoneal chemotherapy (HIPEC) represents a multimodal treatment concept for patients with peritoneal surface malignancies. The use of intraperitoneal cisplatin (CDDP) is associated with a risk of acute kidney injury (AKI). The aim of this study is to evaluate the protective effect of perioperative sodium thiosulfate (STS) administration on kidney function in patients undergoing CRS and CDDP-based HIPEC.

Patients and methods: We retrospectively analyzed clinical data of all patients who underwent CRS and CDDP-based HIPEC at our hospital between March 2017 and August 2020. Patients were stratified according to the use of sodium thiosulfate (STS vs. no STS). We compared kidney function and clinical outcome parameters between both groups and determined risk factors for postoperative AKI on univariate and multivariate analysis. AKI was classified according to acute kidney injury network (AKIN) criteria.

Results: Of 238 patients who underwent CRS and CDDP-based HIPEC, 46 patients received STS and 192 patients did not. There were no significant differences in baseline characteristics. In patients who received STS, a lower incidence (6.5% vs. 30.7%; p = 0.001) and severity of AKI (p = 0.009) were observed. On multivariate analysis, the use of STS (OR 0.089, p = 0.001) remained an independent kidney-protective factor, while arterial hypertension (OR 5.283, p < 0.001) and elevated preoperative urea serum level (OR 5.278, p = 0.032) were predictors for postoperative AKI.

Conclusions: The present data suggest that STS protects patients from AKI caused by CRS and CDDP-based HIPEC. Further prospective studies are needed to validate the benefit of STS among kidney-protective strategies.

© 2021. The Author(s).

Figures

Fig. 1.
Fig. 1.
Consort diagram of analyzed patient cohort. CDDP cisplatin, STS sodium thiosulfate, CR cytoreductive surgery, HIPEC hyperthermic intraperitoneal chemotherapy
Fig. 2.
Fig. 2.
Distribution of tumor entities within the analyzed patient cohort
Fig. 3.
Fig. 3.
Laboratory kidney function parameters before and after CRS and HIPEC. Pre- and postoperative serum levels of creatinine (a), urea (b), and estimated glomerular filtration rate (eGFR, c). STS sodium thiosulfate
Fig. 4.
Fig. 4.
Multivariate analysis of potential risk factors for postoperative acute kidney injury (AKI) following CRS and HIPEC. OR odds ratio (95% confidence interval), BMI body mass index, Preop. preoperative, eGFR estimated glomerular filtration rate

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