Acute kidney injury after cytoreductive surgery and hyperthermic intraoperative cisplatin chemotherapy for malignant pleural mesothelioma
| Autor: | Margaret E. Chen, Raphael Bueno, William G. Richards, Sushrut S. Waikar, Gyorgy Frendl, David E. Leaf, Suraj Sarvode Mothi, Shruti Gupta, Katherin J. Freedberg, Tammy Hod, Shveta S. Motwani |
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| Rok vydání: | 2021 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine Extrapleural Pneumonectomy medicine.medical_specialty Pleural Neoplasms medicine.medical_treatment Operative Time Renal function Antineoplastic Agents 030204 cardiovascular system & hematology Malignancy 03 medical and health sciences Pneumonectomy 0302 clinical medicine Odds Ratio medicine Humans Renal replacement therapy Aged Retrospective Studies Chemotherapy business.industry Mesothelioma Malignant Acute kidney injury Cytoreduction Surgical Procedures Hyperthermia Induced Acute Kidney Injury Length of Stay Middle Aged Decortication medicine.disease Combined Modality Therapy Surgery 030228 respiratory system Female Cisplatin Cardiology and Cardiovascular Medicine business |
| Zdroj: | The Journal of Thoracic and Cardiovascular Surgery. 161:1510-1518 |
| ISSN: | 0022-5223 |
| Popis: | Cytoreductive surgery with hyperthermic intraoperative chemotherapy with cisplatin has been used successfully to treat malignant pleural mesothelioma, a highly aggressive malignancy that is rapidly fatal in most cases. We hypothesized that the combination of ischemic injury with nephrotoxic injury from cisplatin would result in high rates of acute kidney injury.We conducted an observational study in 503 patients to study the risks and outcomes of acute kidney injury after surgical resection of malignant pleural mesothelioma. Eligible subjects underwent extrapleural pneumonectomy or pleurectomy/decortication with or without hyperthermic intraoperative chemotherapy. Acute kidney injury was defined as an increase in creatinine of 26.5 μmol/L or greater within 48 hours of surgery or a 50% or greater increase over 7 days.Acute kidney injury developed in 243 patients (48.3%). Severe acute kidney injury requiring renal replacement therapy developed in 16 patients (3.2%). Major significant predictors for acute kidney injury included male sex (odds ratio, 2.98; P .001), intraoperative cisplatin administration (odds ratio, 3.12; P .001), previous cisplatin exposure (odds ratio, 1.96; P = .02), hypertension (odds ratio, 1.57; P = .02), and longer surgical time (odds ratio, 1.15 per hour; P = .02). Compared with patients without acute kidney injury, those with severe acute kidney injury had longer length of stay (26 vs 13 days) and a 2.71-fold increased risk of death in multivariable-adjusted models.Acute kidney injury is common after cytoreductive surgery with hyperthermic intraoperative chemotherapy with cisplatin and is associated with poor long-term outcomes. Strategies to prevent postoperative acute kidney injury are needed to improve multimodal treatment of malignant pleural mesothelioma. |
| Databáze: | OpenAIRE |
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