Protective Effect of Diuresis During HIPEC: Annals of Surgical Oncology | 2026
Introduction:
Acute kidney injury (AKI) is a frequent and serious complication following cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC), particularly with cisplatin-based regimens. This study evaluated whether maintaining adequate urine output during the HIPEC phase reduces the risk of postoperative AKI.
Why was this study needed?
- AKI is associated with increased morbidity, prolonged hospitalisation, and higher mortality after CRS-HIPEC.
- The optimal intraoperative urine output target during HIPEC has not been established.
- Current renal protection strategies vary widely across institutions.
- Identifying modifiable intraoperative factors could improve perioperative outcomes.
- Better strategies are particularly needed for patients receiving cisplatin-based HIPEC.
Results:
- Higher urine output during the HIPEC phase significantly reduced the risk of postoperative acute kidney injury, independent of total fluid administration and cisplatin exposure.
- An intraoperative urine output threshold of ≥11 mL/kg/hour during HIPEC was identified as the optimal target for renal protection.
- Higher peritoneal cancer burden (PCI ≥20), longer operative time, and low postoperative serum albumin were additional independent predictors of postoperative AKI.
Clinical Impact:
This study provides practical evidence that targeted intraoperative diuresis should be incorporated into CRS-HIPEC protocols, especially during cisplatin-based HIPEC. Maintaining urine output ≥11 mL/kg/hour, together with established nephroprotective measures such as sodium thiosulfate, may reduce postoperative renal injury and improve perioperative outcomes.
Bottom Line:
Maintaining high urine output during the HIPEC phase is associated with a significantly lower risk of acute kidney injury after CRS-HIPEC. Targeted diuresis (≥11 mL/kg/hour) should be considered an important component of renal protection protocols, particularly for patients receiving cisplatin-based HIPEC.
