Author: Gao, Shun-Cai et al.
Anesthesiology. August 2025. doi:10.1097/ALN.0000000000005711
This randomized trial evaluated whether intraoperative urine-guided hydration could reduce acute kidney injury (AKI) in patients undergoing cytoreductive surgery (CRS) and cisplatin-based hyperthermic intraperitoneal chemotherapy (HIPEC) for pseudomyxoma peritonei. A total of 168 adults were randomized to either urine-guided hydration (targeting ≥3 mL·kg⁻¹·h⁻¹ or ≥200 mL·h⁻¹) or routine hydration (≥0.5 mL·kg⁻¹·h⁻¹). The primary outcome was AKI incidence within 7 days after surgery.
Results showed significantly lower AKI with urine-guided hydration (21.4%) compared with routine hydration (39.3%), representing a 45% relative risk reduction. Subgroup analysis confirmed fewer AKI cases when using urine-based diagnostic criteria. Additionally, patients in the urine-guided group experienced fewer major complications within 30 days (36.9% vs. 56.0%). Rates of adverse events were similar between groups, indicating the approach was safe.
What you should know:
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Urine-guided hydration nearly halved postoperative AKI incidence after CRS-HIPEC.
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Patients receiving urine-guided hydration also had fewer major complications.
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The strategy was safe, with no increase in adverse events.
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This targeted hydration approach could become a protective strategy in high-risk oncologic surgeries.
Thank you to Anesthesiology for allowing me to use and summarize this article.