Anesthetics influence the incidence of acute kidney injury following valvular heart surgery

Yoo, Young Chul; Shim, Jæ Kwang; Song, Young Goo; Yang, So Young; Kwak, Young Lan

doi:10.1038/ki.2013.532

Cited by 85 publications

(72 citation statements)

References 39 publications

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“…In this matched population, propofol was associated with statistically lower risk for developing AKI and several other important renal-related outcomes. The results of this propensity score analysis, which controlled for important pretreatment variables and for mechanical ventilation dependence, are supported by previous animal studies and one small but important randomized clinical trial in patients undergoing valvular heart surgery (8,10,11).…”

Section: Discussionmentioning

confidence: 49%

“…Several animal studies suggested that propofol is effective in attenuating AKI in different models (8)(9)(10). Although it is commonly observed that therapeutic and preventive strategies related to AKI are successful in animal models and fail in human trials, a recent randomized controlled study showed that propofol anesthesia was associated with a reduction in AKI incidence in patients undergoing valvular heart surgery compared with sevoflurane anesthesia (11). Although these findings are intriguing, our enthusiasm is limited by the small number of patients involved and conflicting results with similar previous small trials also testing propofol.…”

Section: Introductionmentioning

confidence: 99%

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Renal Outcomes in Critically Ill Patients Receiving Propofol or Midazolam

Leite

Macedo

Martins

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Propofol has been shown to provide protection against renal ischemia/reperfusion injury experimentally, but clinical evidence is limited to patients undergoing cardiac surgery. There are no data about its association with oliguria and AKI in critically ill patients.Design, setting, participants, & measurements We obtained data from the Multiparameter Intelligent Monitoring in Intensive Care II database (2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008). Patient selection criteria included adult patients in their first intensive care unit (ICU) admission, need for mechanical ventilation, and treatment with propofol or midazolam. Propensity score analysis (1:1) was used and renal-related outcomes (AKI, oliguria, cumulative fluid balance, and need for RRT) were evaluated during the first 7 days of ICU stay.Results There were 1396 propofol/midazolam-matched patients. AKI in the first 7-day ICU time period was statistically lower in propofol-treated patients compared with midazolam-treated patients (55.0% versus 67.3%, P,0.001). Propofol was associated with lower AKI incidence using both urine output (45.0% versus 55.7%, P,0.001) and serum creatinine criteria (28.8% versus 37.2%, P=0.001). Patients receiving propofol had oliguria (,400 ml/d) less frequently (12.4% versus 19.6%, P=0.001) and had diuretics prescribed less often (8.5% versus 14.3%, P=0.001). In addition, during the first 7 days of ICU stay, patients receiving propofol less frequently achieved cumulative fluid balance .5% of body weight (50.1% versus 58.3%, P=0.01). The need for RRT in the first 7 days of ICU stay was also less frequent in propofol-treated patients (3.4% versus 5.9%, P=0.03). ICU mortality was lower in propofol-treated patients (14.6% versus 29.7%, P,0.001). ConclusionsIn this large, propensity-matched ICU population, patients treated with propofol had a lower risk of AKI, fluid-related complications, and need for RRT.

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Section: Discussionmentioning

confidence: 49%

Section: Introductionmentioning

confidence: 99%

Renal Outcomes in Critically Ill Patients Receiving Propofol or Midazolam

Leite

Macedo

Martins

et al. 2015

Clinical Journal of the American Society of Nephrology

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“…Measured perioperative changes in serum biomarkers of renal injury and inflammatory mediators, and the occurrence of postoperative complications contributed to the clinical evaluation of patient outcomes. C-reactive protein, creatine kinase-MB, and neutrophil counts were measured pre- and postoperatively, and interleukin-1, interleukin-6, and tumor necrosis factor-α levels were assessed to evaluate the degree of inflammation and AKI [61]. In another study, patients treated with propofol had better ICU survival than those treated with benzodiazepine.…”

Section: General Anesthesiamentioning

confidence: 99%

“…In a comparison between patients receiving propofol or sevoflurane during cardiopulmonary bypass, propofol significantly reduced the incidence and severity of AKI (which was defined using the AKI network criteria as an absolute increase in serum creatinine of 0.3 mg/dL, an increase ≥150% from the baseline value, or as a urine output of <0.5 mL/kg/h for >6 h within 48 h postoperative) in comparison to sevoflurane [61]. This suggests that propofol may be a better renoprotective agent for cardiopulmonary bypass than sevoflurane.…”

Section: General Anesthesiamentioning

confidence: 99%

A Review of Anesthetic Effects on Renal Function: Potential Organ Protection

et al. 2017

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Background: Renal protection is a critical concept for anesthesiologists, nephrologists, and urologists, since anesthesia and renal function are highly interconnected and can potentially interfere with one another. Therefore, a comprehensive understanding of anesthetic drugs and their effects on renal function remains fundamental to the success of renal surgeries, especially transplant procedures. Some experimental studies have shown that some anesthetics provide protection against renal ischemia/reperfusion (IR) injury, but there is limited clinical evidence. Summary: The effects of anesthetic drugs on renal failure are particularly important in the context of kidney transplantation, since the conditions of preservation following removal profoundly influence the recovery of organ function. Currently, preservation procedures are typically based on the usage of a cold-storage solution. Some anesthetic drugs induce anti-inflammatory, anti-necrotic, and anti-apoptotic effects. A more thorough understanding of anesthetic effects on renal function can present a novel approach for developing organ-protective strategies. The aim of this review is to discuss the effects of different anesthetic drugs on renal function, with particular focus on IR injury. Many studies have demonstrated the organ-protective effects of some anesthetic drugs, specifically propofol, which indicate the potential of some anesthetics to introduce novel organ protective targets. This is not surprising, since lipid emulsions are major components of propofol, which accumulating data show provide organ protective effects against IR injury. Key Messages: Thorough understanding of the interaction between anesthetic drugs and renal function remains fundamental to the delivery of safe perioperative care and to optimizing outcomes after renal surgeries, particularly transplant procedures. Anesthetics can be repurposed for organ protection with more information about their effects, especially during transplant procedures. Here, we review the effects of different anesthetic drugs – specifically those that contain lipids in their structure, with special reference to IR injury.

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“…In parallel with the increase in the number of studies demonstrating the protective role of sevofl urane against the occurrence of AKI, there is also a large number of studies on the protective eff ects of other anesthetics, such as propofol, with regard to AKI. While some studies point to a stronger protective effect of propofol as compared with sevofl urane relative to the occurrence of AKI 24 , others demonstrated that there were no statistically signifi cant diff erences in the incidence of AKI between the two groups 25,26 .…”

Section: Modulation Of Ischemia/reperfusion Injury and Anti-infl Ammamentioning

confidence: 99%

Effect of Inhalational Anesthetics on Acute Kidney Injury

Bublić

Tonković

Sakan³

et al. 2016

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SUMMARY -Acute kidney injury (AKI) is a serious complication associated with increased morbidity and mortality. Total incidence of AKI in hospitalized patients is 1%-5%. As many as 30% of these patients develop AKI in the perioperative period, which is associated with anesthesia and surgery. Despite scientifi c advances and improved surgery techniques, as well as treatment in intensive care units, no signifi cant decrease in AKI incidence has been achieved. To change this outcome, it is important to identify patients at risk of AKI and prevent its occurrence. Correct selection of anesthetic drugs during general anesthesia, adjusted to the individual needs of patients, also infl uences the overall outcome of treatment. Nowadays, inhalational anesthetics are not considered nephrotoxic. Th e more so, inhalational anesthetics have a strong and direct protective eff ect on many organs through preconditioning and postconditioning. New studies have shown that sevofl urane diminishes ischemia/ reperfusion kidney injury and has an anti-infl ammatory eff ect, thus having the potential to reduce the occurrence of AKI. Given the incidence of AKI in the perioperative period, as well as new fi ndings about anesthetics, the issue of anesthetic selection during general anesthesia might be of crucial importance for the fi nal outcome of treatment.

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Anesthetics influence the incidence of acute kidney injury following valvular heart surgery

Cited by 85 publications

References 39 publications

Renal Outcomes in Critically Ill Patients Receiving Propofol or Midazolam

Renal Outcomes in Critically Ill Patients Receiving Propofol or Midazolam

A Review of Anesthetic Effects on Renal Function: Potential Organ Protection

Effect of Inhalational Anesthetics on Acute Kidney Injury

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