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Abstract: PO0022

The Association of Intraoperative Gross Hematuria on Postoperative AKI After Cytoreductive Surgery Combined with Hyperthermic Intraperitoneal Chemotherapy: A Retrospective Study

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Mitani, Yumi, Kokuritsu Kenkyu Kaihatsu Hojin Kokuritsu Kokusai Iryo Kenkyu Center, Shinjuku-ku, Tokyo, Japan
  • Arai, Yohei, Kokuritsu Kenkyu Kaihatsu Hojin Kokuritsu Kokusai Iryo Kenkyu Center, Shinjuku-ku, Tokyo, Japan
  • Mitani, Tomohiro, Tokyo Daigaku Daigakuin Igakukei Kenkyuka Igakubu, Bunkyo-ku, Tokyo, Japan
  • Gohda, Yoshimasa, Kokuritsu Kenkyu Kaihatsu Hojin Kokuritsu Kokusai Iryo Kenkyu Center, Shinjuku-ku, Tokyo, Japan
  • Kondo, Isao, Kokuritsu Kenkyu Kaihatsu Hojin Kokuritsu Kokusai Iryo Kenkyu Center, Shinjuku-ku, Tokyo, Japan
  • Sakamoto, Emi, Kokuritsu Kenkyu Kaihatsu Hojin Kokuritsu Kokusai Iryo Kenkyu Center, Shinjuku-ku, Tokyo, Japan
  • Katagiri, Daisuke, Kokuritsu Kenkyu Kaihatsu Hojin Kokuritsu Kokusai Iryo Kenkyu Center, Shinjuku-ku, Tokyo, Japan
  • Hinoshita, Fumihiko, Kokuritsu Kenkyu Kaihatsu Hojin Kokuritsu Kokusai Iryo Kenkyu Center, Shinjuku-ku, Tokyo, Japan
Background

Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (CRS+HIPEC) has been established in the management of peritoneal carcinomatosis (PC). Although it’s still necessary to take adequate measures against major postoperative complications including acute kidney injury (AKI), there is no consensus on how to assess and stratify risk for patients with postoperative AKI following CRS+HIPEC. The aim of this retrospective cohort study is to investigate the association of intraoperative gross hematuria as a surrogate marker of ureter injury with post-operative AKI incidence.

Methods

We conducted a retrospective cohort study consisting of patients without impaired pre-operative kidney function who underwent CRS+HIPEC at a single referral center, Center Hospital of the National Center for Global Health and Medicine, and evaluated the relationship between intra-operative gross hematuria and the incidence of post-operative AKI defined by the Kidney Disease Improving Global Outcomes practice guidelines. We estimated the adjusted odds ratio of hematuria for AKI by multivariate logistic regression with linear terms of intra-operative hematuria, PC index score(PCI), sum of the subscores for abdominoperitoneal region 4-8(4:left flank, 5: left lower, 6: pelvis, 7: right lower,8:right flank) of PCI ，Body Mass Index, estimated blood loss, age, pre-operative estimated glomerular filtration rate and platina-based infusion (cisplatin) without any interaction terms.

Results

We enrolled 185 patients (males, 37%) and 25 patients developed intra-operative gross hematuria. Post-operative AKI occurred in 10 (40%) of 25patients with hematuria and 28 (17.5%) of 160 patients without hematuria. The crude odds ratio for exposed to hematuria was 3.14 (95% confidence interval: 1.30-7.60, p=0.020) for post-operative AKI. Adjusted odds ratio estimated by the multivariate logistic regression was 4.57 (95% confidence interval : 1.55-13.45, p=0.006).

Conclusion

We first disclosed that the intra-operative gross hematuria is significantly associated with post-operative AKI incidence after CRS+HIPEC.