Commentary: Acute kidney injury after intrapleural cisplatin: Minimizing collateral damage

Our plain-English summary of Commentary: Acute kidney injury after intrapleural cisplatin: Minimizing collateral damage, by M.I. Ebright (The Journal of Thoracic and Cardiovascular Surgery, 2021).

The study

• Author: M.I. Ebright
• Journal: The Journal of Thoracic and Cardiovascular Surgery
• Published: 2021;161(4):1522-1523
• Type of article: Editorial, Comment
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher

In plain English

This is a short commentary, not an original study. The author, a thoracic surgeon at Columbia University Medical Center, discussed a separate study by Hod and colleagues in the same journal. As described here, that study looked back at a database of 503 patients who had surgery for malignant pleural mesothelioma over a 9-year period: 241 had extrapleural pneumonectomy and 262 had pleurectomy/decortication. Of these, 312 received heated cisplatin chemotherapy inside the chest during the operation (HIOC). According to the commentary, more than 50% of patients who received HIOC developed acute kidney injury, compared with about 25% of those who did not. Most kidney injuries (78%) were the mildest stage. Of 22 patients with the most severe stage, 16 required dialysis, and all 16 had received HIOC. Patients given HIOC had a lower risk of death, but this benefit was cancelled out in those who developed kidney injury. The author noted that survival was not the study's main endpoint. The author concluded that HIOC has significant kidney toxicity and a fragile survival benefit, and that it should be avoided in patients at elevated risk of even mild kidney injury.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Invited commentary on a separate retrospective observational study (Hod and colleagues); this article reports no new data of its own
• Who was studied: As described in the commentary, the Hod et al. study included 503 patients who underwent surgery for malignant pleural mesothelioma over a 9-year period: extrapleural pneumonectomy in 241 and pleurectomy/decortication in 262. The data came from that institution's prospectively maintained database.
• Exposure: Hyperthermic intraoperative cisplatin chemotherapy (HIOC) given during cytoreductive surgery for malignant pleural mesothelioma. Asbestos exposure is not discussed.
• Main results:
  • In the Hod et al. study, as summarized by the commentary, HIOC was given to 312 of the 503 patients.
  • In the Hod et al. study, as summarized, more than 50% of patients who received HIOC developed acute kidney injury.
  • In the Hod et al. study, as summarized, approximately 25% of patients who did not receive HIOC also developed acute kidney injury.
  • In the Hod et al. study, as summarized, 78% of patients who developed acute kidney injury were classified as KDIGO stage I, the mildest stage.
  • In the Hod et al. study, as summarized, the risk factors for acute kidney injury were male sex, HIOC, previous cisplatin exposure, hypertension and longer operative time.
  • In the Hod et al. study, as summarized, 22 patients developed KDIGO stage III (severe) kidney injury. Sixteen of them required dialysis, and all 16 had received HIOC.
  • In the Hod et al. study, as summarized, patients who received HIOC had a lower risk of death but a higher risk of acute kidney injury.
  • In the Hod et al. study, as summarized, the survival benefit of HIOC was nullified in patients who developed acute kidney injury, including stage I. Improved survival was seen in those who received HIOC and avoided kidney injury.
• The authors' conclusion: The author concluded that hyperthermic intraoperative cisplatin has significant kidney toxicity and a fragile survival benefit. In the author's view, it may be better to avoid it altogether in patients at elevated risk of even mild acute kidney injury.
• Limitations the authors state:
  • The author noted that survival was not a primary endpoint of the Hod et al. study.
  • The author noted that KDIGO stage I kidney injury might not be recognized in routine postoperative care, because serum creatinine may stay within the normal reference range.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Cisplatin.

Related studies

• Acute kidney injury after cytoreductive surgery and hyperthermic intraoperative cisplatin chemotherapy for malignant pleural mesothelioma — T. Hod, K.J. Freedberg, et al. (2021)
• Pemetrexed induced acute kidney injury in patients with non-small cell lung cancer: reversible and chronic renal damage — G. Rombolà, F. Vaira, et al. (2015)
• Detection of Drug-Induced Acute Kidney Injury in Humans Using Urinary KIM-1, miR-21, -200c, and -423 — M. Pavkovic, C. Robinson-Cohen, et al. (2016)
• Commentary: Cisplatin-induced nephrotoxicity following cytoreductive surgery and heated intraoperative chemotherapy for malignant pleural mesothelioma — S.S. Groth, R.T. Ripley (2021)
• Use of postoperative creatinine to predict sustained kidney injury in patients undergoing mesothelioma surgery — K.A. Mizuguchi, A. Mitani, et al. (2012)
• Commentary: Winning the battle for local control without losing war for survival against malignant pleural mesothelioma — A. Bribriesco (2021)

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