A prospective pilot study of kidney-specific biomarkers to detect acute kidney injury after cytoreduction and hyperthermic intraperitoneal chemotherapy

Background: Acute kidney injury (AKI) is a critical morbidity after cytoreduction and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC). Objective: This study was conducted to investigate the use of kidney-specific biomarkers to evaluate the diagnostic accuracy of post-HIPEC AKI. Methods: Patients who received CRS/HIPEC were prospectively enrolled in this study. We serially sampled urine neutrophil gelatinase-associated lipocalin (NGAL), serum cystatin C (sCyC), and β2 microglobulin (sβ2-MG) on the day before CRS/HIPEC and then 2 h, 1 d, 2 d, 3 d, and 7 d after CRS/HIPEC. The primary outcome was the occurrence of AKI during the first 7 d. The areas under the receiver operating characteristic curve (AUCs) were calculated to evaluate the detection performance. Results: A total of 75 patients were eligible, of whom 5 (6.7%) fulfilled the criteria of AKI during the study period (AKI group) and 70 did not (non-AKI group). No significant differences were observed in these biomarkers between the two groups, except for sβ2-MG on day 3 (P = 0.025). Regarding changes in biomarker concentrations, the AKI group had a significantly higher concentration range of sCyC on day 3 (P = 0.009) and sβ2-MG on day 1 and day 3 (P = 0.013 and 0.019). Conclusions: This is the first prospective study to evaluate the value of kidney-specific biomarkers in patients after CRS/HIPEC. We found that AKI cannot be predicted by simply using the absolute measurements of these biomarkers because of the heterogeneous characteristics of the patients.