Authors: Gao, Shun-Cai et al.
Anesthesiology, August 13, 2025. DOI: 10.1097/ALN.0000000000005711
This randomized clinical trial investigated whether intraoperative urine output–guided hydration can reduce the incidence of acute kidney injury (AKI) after cytoreductive surgery (CRS) combined with cisplatin-based hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with pseudomyxoma peritonei. AKI is a frequent and serious complication of this intensive procedure, and optimizing hydration remains a critical preventive strategy.
A total of 168 adult patients were randomized to receive either urine-guided hydration (targeting ≥3 mL·kg⁻¹·h⁻¹ or ≥200 mL·h⁻¹ urine output) or routine hydration (targeting ≥0.5 mL·kg⁻¹·h⁻¹). The primary endpoint was AKI within 7 days postoperatively, defined by Kidney Disease Improving Global Outcomes (KDIGO) criteria.
Results demonstrated a significantly lower AKI rate in the urine-guided group compared with routine hydration (21.4% vs. 39.3%; relative risk 0.55, 95% CI 0.33–0.89, P=0.012). Urine-guided hydration also reduced the proportion of patients meeting AKI criteria based on oliguria and decreased the 30-day major complication rate (36.9% vs. 56.0%; relative risk 0.66, P=0.013). No increase in adverse events was observed, indicating the approach was safe and well tolerated.
These findings suggest that maintaining higher intraoperative urine output through targeted hydration can significantly reduce postoperative AKI risk and improve short-term outcomes in CRS-HIPEC patients.
What You Should Know:
Urine output–guided hydration during CRS-HIPEC nearly halved the risk of AKI and reduced postoperative complications without increasing adverse events. This strategy provides a practical, physiologic, and safe approach to renal protection in complex oncologic surgeries.
Thank you to Anesthesiology for publishing this clinically relevant trial advancing perioperative kidney protection strategies in high-risk surgical patients.