Association of intraoperative gross hematuria with acute kidney injury after cytoreductive surgery

Yumi Mitani; Yohei Arai; Tomohiro Mitani; Yoshimasa Gohda; Hideaki Yano; Isao Kondo; Emi Sakamoto; Daisuke Katagiri; Fumihiko Hinoshita

doi:10.1515/pp-2021-0145

Association of intraoperative gross hematuria with acute kidney injury after cytoreductive surgery

Pleura Peritoneum. 2022 Feb 18;7(1):19-26. doi: 10.1515/pp-2021-0145. eCollection 2022 Mar 1.

Authors

Yumi Mitani¹, Yohei Arai², Tomohiro Mitani³, Yoshimasa Gohda⁴, Hideaki Yano⁴, Isao Kondo¹, Emi Sakamoto¹, Daisuke Katagiri¹, Fumihiko Hinoshita^{1

5}

Affiliations

¹ Department of Nephrology, National Center for Global Health and Medicine, Tokyo, Japan.
² Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
³ Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
⁴ Department of Surgery, National Center for Global Health and Medicine, Tokyo, Japan.
⁵ Department of Nursing, Faculty of Health Care and Medical Sports, Teikyo Heisei University, Tokyo, Japan.

Abstract

Objectives: Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) has been established in the management of peritoneal carcinomatosis. Although it is still necessary to take adequate measures against major postoperative complications including acute kidney injury (AKI), consensus is lacking on how to assess and stratify risk for patients with postoperative AKI after CRS-HIPEC. The aim of this retrospective cohort study was to investigate the association of intraoperative gross hematuria as a surrogate marker of ureter injury with postoperative AKI incidence.

Methods: This retrospective cohort study investigated patients without impaired preoperative kidney function who underwent CRS-HIPEC at a single referral center, and evaluated the relationship between intraoperative gross hematuria and incidence of postoperative AKI as defined by the Kidney Disease Improving Global Outcomes practice guidelines. Logistic regression analysis was performed to calculate the odds ratio of intraoperative gross hematuria for AKI, adjusting for confounding factors and other risk factors for AKI.

Results: We enrolled 185 patients (males, 37%). Twenty-five patients developed intraoperative gross hematuria. Postoperative AKI occurred in 10 (40%) of 25 patients with hematuria and 28 (17.5%) of 160 patients without hematuria. The crude odds ratio for exposure to hematuria was 3.14 (95% confidence interval, 1.30-7.60; p=0.020) for postoperative AKI. Adjusted odds ratio as estimated by multivariate logistic regression was 4.57 (95% confidence interval, 1.55-13.45; p=0.006).

Conclusions: Intraoperative gross hematuria is significantly associated with postoperative AKI incidence after CRS-HIPEC.

Keywords: acute kidney injury; cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC); intraoperative gross hematuria; ureter injury.