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Abstract：
Background: Cisplatin is employed in hyperthermic intraperitoneal chemotherapy (HIPEC) after cytoreductive surgery (CRS) for peritoneal surface malignancies (PSMs). The main concern regarding intraperitoneal cisplatin administration is nephrotoxicity. Numerous reports in this context are available. Our objective was to conduct a systematic review and meta-analysis to assess cisplatin-based HIPEC-related nephrotoxicity (CHRN). Methods: A systematic literature review on CHRN after CRS for the treatment of PSMs was performed. The literature search was carried out using Medline, Cochrane, and Embase. The last day of the search was 23 October 2023. PRISMA guidelines were used. A meta-analysis was then conducted. The main endpoint was the incidence of acute and chronic renal impairment after CHRN. Secondary endpoints included the potential impact of several clinical variables on the primary endpoint and a critical appraisal of the different renal impairment scales employed. Results: Our study included 26 articles with a total sample of 1473 patients. The incidence of acute kidney injury (AKI) was 18.6% (95% CI: 13.6-25%, range of true effects 3-59%). For chronic kidney disease, it was 7% (95% CI: 3-15.3%, range of true effects 1-53%). The variables that statistically influenced these results were the scale used to measure renal insufficiency, the use of nephroprotective agents, and the presence of pre-existing renal disease. Conclusions: The reported incidence of renal impairment following cisplatin-based HIPEC is highly variable. The incidence of renal failure obtained in this meta-analysis should be used as a reference for subsequent reports on this topic. Further prospective studies are warranted to establish optimal and standardized management.
摘要：
背景：顺铂用于腹膜表面恶性肿瘤（PSM）的细胞减灭术（CRS）后的腹腔热化疗（HIPEC）。关于腹膜内顺铂给药的主要问题是肾毒性。这方面有许多报告。我们的目的是进行系统评价和荟萃分析，以评估基于顺铂的HIPEC相关肾毒性（CHRN）。方法：对CRS后CHRN治疗PSM进行系统的文献综述。使用Medline进行文献检索，科克伦,和Embase。搜索的最后一天是2023年10月23日。使用PRISMA指南。然后进行荟萃分析。主要终点是CHRN后急性和慢性肾功能损害的发生率。次要终点包括几个临床变量对主要终点的潜在影响以及对所采用的不同肾损害量表的关键评估。结果：我们的研究包括26篇文章，共1473例患者。急性肾损伤(AKI)发生率为18.6%(95%CI:13.6-25%,真实影响范围3-59%)。对于慢性肾病，为7%(95%CI：3-15.3%，真实影响范围1-53%)。在统计学上影响这些结果的变量是用于测量肾功能不全的量表，使用肾保护剂，和预先存在的肾脏疾病的存在。结论：报告的基于顺铂的HIPEC后肾损害的发生率是高度可变的。此荟萃分析中获得的肾衰竭发生率应用作后续有关此主题的报告的参考。需要进一步的前瞻性研究来建立最佳和标准化的管理。
