Acute Kidney Injury After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy in a Portuguese Population

Nephrotoxicity Associated with Cytoreductive Surgery Combined with Cisplatin-Based Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Malignant Disease: A Systematic Review and Meta-Analysis

Background: Cisplatin is employed in hyperthermic intraperitoneal chemotherapy (HIPEC) after cytoreductive surgery (CRS) for peritoneal surface malignancies (PSMs). The main concern regarding intraperitoneal cisplatin administration is nephrotoxicity. Numerous reports in this context are available. Our objective was to conduct a systematic review and meta-analysis to assess cisplatin-based HIPEC-related nephrotoxicity (CHRN). Methods: A systematic literature review on CHRN after CRS for the treatment of PSMs was performed. The literature search was carried out using Medline, Cochrane, and Embase. The last day of the search was 23 October 2023. PRISMA guidelines were used. A meta-analysis was then conducted. The main endpoint was the incidence of acute and chronic renal impairment after CHRN. Secondary endpoints included the potential impact of several clinical variables on the primary endpoint and a critical appraisal of the different renal impairment scales employed. Results: Our study included 26 articles with a total sample of 1473 patients. The incidence of acute kidney injury (AKI) was 18.6% (95% CI: 13.6-25%, range of true effects 3-59%). For chronic kidney disease, it was 7% (95% CI: 3-15.3%, range of true effects 1-53%). The variables that statistically influenced these results were the scale used to measure renal insufficiency, the use of nephroprotective agents, and the presence of pre-existing renal disease. Conclusions: The reported incidence of renal impairment following cisplatin-based HIPEC is highly variable. The incidence of renal failure obtained in this meta-analysis should be used as a reference for subsequent reports on this topic. Further prospective studies are warranted to establish optimal and standardized management.

Discerning biomimetic nanozyme electrodes based on g-C3N4 nanosheets and molecularly imprinted polythiophene nanofibers for detecting creatinine in microliter droplets of human saliva

The growing risk of death associated with kidney dysfunction underlines the requirement for a cost-effective and precise point-of-care (POC) diagnostic tool to identify chronic kidney disease (CKD) at an early stage. This work reports the development of a non-invasive POC diagnostic based on cost-efficient, disposable electrodes and in situ-designed biomimetic nanozymes. The nanozymes are composed of graphitic carbon nitride nanosheets (gCN) and creatinine-imprinted polythiophene nanofibers (miPTh). Microscopic analyses reveal porous nanofibrous surface morphology of biomimetic miPTh/gCN nanozymes. Bulk imprinting and the inclusion of conductive gCN nanosheets drastically reduced the charge transfer resistance and improved the electron exchange kinetics at the nanozyme-electrolyte interface. The electrochemical oxidation of creatinine is studied via cyclic voltammetry (CV), and differential pulse voltammetry (DPV), which exhibit excellent creatinine recognition ability of biomimetic miPTh/gCN nanozyme sensors compared to pristine polymeric or non-imprinted nanozymes. The sensor reveals linear response toward 200-1000 nmol L-1 creatinine, high sensitivity (4.27 μA cm-2 nmol-1 L), sub-nanomolar detection limit (340 pmol L-1), and excellent selectivity over common salivary analytes. To corroborate its real-world utility, the miPTh/gCN nanozyme sensor shows an impressive 94.8% recovery of spiked creatinine concentrations in microliter droplets of human saliva samples. This disposable sensor reveals great potential in the realm of reliable and efficient non-invasive POC diagnostics for healthcare delivery.