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Prophylactic sodium thiosulfate reduces the risk and severity of acute kidney injury in oxaliplatin-based hyperthermic intraperitoneal chemotherapy

Algethami, Nader LU ; Valdimarsson, Valentinus LU orcid ; Verwaal, Victor LU and Syk, Ingvar LU (2026) In World Journal of Gastrointestinal Oncology 18(7). p.1-13
Abstract

BACKGROUND Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) has improved outcomes for patients with peritoneal carcinomatosis (PC). However, this treatment carries a significant risk of acute kidney injury (AKI), especially with cisplatin-based regimens. Sodium thiosulfate (ST) is established as a nephroprotective treatment in cisplatin-based HIPEC, but its efficacy in oxaliplatin-based HIPEC remains unexplored. AIM To evaluate the protective effects of ST in patients undergoing oxaliplatin-based HIPEC for colorectal PC. METHODS This retrospective single-center study included 119 patients who underwent CRS combined with oxaliplatin-based HIPEC for colorectal PC between 2018 and 2024. ST was... (More)

BACKGROUND Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) has improved outcomes for patients with peritoneal carcinomatosis (PC). However, this treatment carries a significant risk of acute kidney injury (AKI), especially with cisplatin-based regimens. Sodium thiosulfate (ST) is established as a nephroprotective treatment in cisplatin-based HIPEC, but its efficacy in oxaliplatin-based HIPEC remains unexplored. AIM To evaluate the protective effects of ST in patients undergoing oxaliplatin-based HIPEC for colorectal PC. METHODS This retrospective single-center study included 119 patients who underwent CRS combined with oxaliplatin-based HIPEC for colorectal PC between 2018 and 2024. ST was introduced in 2022, and patients were grouped as ST-treated (n = 46) and non-ST-treated (n = 73) based on the treatment period. The primary endpoint was the incidence of AKI. Secondary outcomes were postoperative plasma creatinine levels, estimated glomerular filtration rate, severity of AKI, and rate of postoperative complications. Outcomes were analyzed using multivariate logistic regression, including sensitivity analysis. RESULTS The incidence of AKI was significantly lower in the ST-treated group (28%) compared with the non-ST-treated group (66%). Multivariate analysis confirmed ST as an independent factor associated with a reduced risk of AKI. Peak plasma creatinine and mean postoperative creatinine levels were also significantly lower in the ST-treated group. The rate of postoperative complications other than AKI was similar between the groups. CONCLUSION Prophylactic administration of ST significantly reduces the incidence and severity of AKI in patients undergoing CRS combined with oxaliplatin-based HIPEC. These findings suggest that ST may be considered as a nephroprotective strategy in oxaliplatin-based HIPEC protocols; however, further prospective studies are warranted to confirm these results.

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author
; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Acute kidney injury, Hyperthermic intraperitoneal chemotherapy, Oxaliplatin, Peritoneal carcinomatosis, Peritoneal surface malignancy, Sodium thiosulfate
in
World Journal of Gastrointestinal Oncology
volume
18
issue
7
article number
118400
pages
1 - 13
publisher
Baishideng Publishing Group Inc
external identifiers
  • scopus:105045354600
DOI
10.4251/wjgo.v18.i7.118400
language
English
LU publication?
yes
additional info
Publisher Copyright: ©Author(s) 2026.
id
55e1e219-7c26-4336-a3b9-089800ff8346
date added to LUP
2026-10-06 12:15:52
date last changed
2026-10-07 03:08:59
@article{55e1e219-7c26-4336-a3b9-089800ff8346,
  abstract     = {{<p>BACKGROUND Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) has improved outcomes for patients with peritoneal carcinomatosis (PC). However, this treatment carries a significant risk of acute kidney injury (AKI), especially with cisplatin-based regimens. Sodium thiosulfate (ST) is established as a nephroprotective treatment in cisplatin-based HIPEC, but its efficacy in oxaliplatin-based HIPEC remains unexplored. AIM To evaluate the protective effects of ST in patients undergoing oxaliplatin-based HIPEC for colorectal PC. METHODS This retrospective single-center study included 119 patients who underwent CRS combined with oxaliplatin-based HIPEC for colorectal PC between 2018 and 2024. ST was introduced in 2022, and patients were grouped as ST-treated (n = 46) and non-ST-treated (n = 73) based on the treatment period. The primary endpoint was the incidence of AKI. Secondary outcomes were postoperative plasma creatinine levels, estimated glomerular filtration rate, severity of AKI, and rate of postoperative complications. Outcomes were analyzed using multivariate logistic regression, including sensitivity analysis. RESULTS The incidence of AKI was significantly lower in the ST-treated group (28%) compared with the non-ST-treated group (66%). Multivariate analysis confirmed ST as an independent factor associated with a reduced risk of AKI. Peak plasma creatinine and mean postoperative creatinine levels were also significantly lower in the ST-treated group. The rate of postoperative complications other than AKI was similar between the groups. CONCLUSION Prophylactic administration of ST significantly reduces the incidence and severity of AKI in patients undergoing CRS combined with oxaliplatin-based HIPEC. These findings suggest that ST may be considered as a nephroprotective strategy in oxaliplatin-based HIPEC protocols; however, further prospective studies are warranted to confirm these results.</p>}},
  author       = {{Algethami, Nader and Valdimarsson, Valentinus and Verwaal, Victor and Syk, Ingvar}},
  keywords     = {{Acute kidney injury; Hyperthermic intraperitoneal chemotherapy; Oxaliplatin; Peritoneal carcinomatosis; Peritoneal surface malignancy; Sodium thiosulfate}},
  language     = {{eng}},
  month        = {{07}},
  number       = {{7}},
  pages        = {{1--13}},
  publisher    = {{Baishideng Publishing Group Inc}},
  series       = {{World Journal of Gastrointestinal Oncology}},
  title        = {{Prophylactic sodium thiosulfate reduces the risk and severity of acute kidney injury in oxaliplatin-based hyperthermic intraperitoneal chemotherapy}},
  url          = {{http://dx.doi.org/10.4251/wjgo.v18.i7.118400}},
  doi          = {{10.4251/wjgo.v18.i7.118400}},
  volume       = {{18}},
  year         = {{2026}},
}