General Anesthetic Agents and Renal Function after Nephrectomy

Lee, Ho Jin; Bae, Je Hyun; Kwon, Yongsuk; Jang, Hwan Suk; Yoo, Seokha; Jeong, Chang Wook; Kim, Jin Tae

doi:10.3390/jcm8101530

Cited by 14 publications

(9 citation statements)

References 47 publications

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“…Several studies have compared the incidence of postoperative AKI between propofol and volatile anesthetic agents. In accordance with our results, some retrospective studies of nephrectomy, colorectal surgery, and major abdominal surgery demonstrated that propofol was associated with a reduced incidence of postoperative AKI [ 10 , 11 , 12 , 13 ]. In addition, patients treated with propofol had lower kidney specific biomarkers, pro-inflammatory cytokines, and incidences of postoperative AKI compared with those treated with sevoflurane during major abdominal or cardiac surgery [ 14 , 15 ].…”

Section: Discussionsupporting

confidence: 92%

Effects of Anesthetic Technique on the Occurrence of Acute Kidney Injury after Spine Surgery: A Retrospective Cohort Study

Han

Koo

et al. 2021

JCM

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The effects of anesthetics on acute kidney injury (AKI) after spine surgery have not been evaluated fully. This study compared propofol-based total intravenous anesthesia (TIVA) and volatile anesthetics in the development of AKI after spine surgery. This retrospective study reviewed patients who underwent spine surgery between 2015 and 2019. A logistic regression analysis was performed to identify risk factors for AKI. Additionally, after propensity score matching, the incidence of AKI was compared between TIVA and volatile groups. Of the 4473 patients, 709 were excluded and 3764 were included in the logistic regression. After propensity score matching, 766 patients from each group were compared, and we found that the incidence of AKI was significantly lower in the TIVA group (1% vs. 4.2%, p < 0.001). In the multivariate logistic regression analysis, the risk factors for postoperative AKI were male sex (OR 1.85, 95% CI 1.18–3.06), hypertension (OR 2.48, 95% CI 1.56–3.94), anemia (OR 2.66, 95% CI 1.76–4.04), and volatile anesthetics (OR 4.69, 95% CI 2.24–9.84). Compared with volatile anesthetics, TIVA is associated with a reduced risk of AKI for patients who have undergone spine surgery.

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Section: Discussionsupporting

confidence: 92%

Effects of Anesthetic Technique on the Occurrence of Acute Kidney Injury after Spine Surgery: A Retrospective Cohort Study

Han

Koo

et al. 2021

JCM

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“…A previous pilot study reported that remote ischemic conditioning reduced the incidence of AKI in patients undergoing partial nephrectomy [48]. Further studies are required to find modifiable risk factors of AKI or CKD progression after radical nephrectomy [9] and determinants for adaptive hyperfiltration in the contralateral kidney [39].…”

Section: Discussionmentioning

confidence: 99%

“…Demographic, baseline characteristics, and surgery-related data which were known to be associated with renal function after nephrectomy were obtained from our electronic medical records (Table 1) [1][2][3]9]. Serum creatinine values measured at 3, 12, 24, 36 months after surgery were collected.…”

Section: Patient Data and Outcome Measurementsmentioning

confidence: 99%

Robust Association between Acute Kidney Injury after Radical Nephrectomy and Long-term Renal Function

Shin

Jang

et al. 2020

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The association between acute kidney injury (AKI) and long-term renal function after radical nephrectomy has not been evaluated fully. We reviewed 558 cases of radical nephrectomy. Postoperative AKI was defined by the Kidney Disease: Improving Global Outcomes (KDIGO) serum creatinine criteria. Values of estimated glomerular filtration rate (eGFR) were collected up to 36 months (median 35 months) after surgery. The primary outcome was new-onset chronic kidney disease (CKD) stage 3a or higher or all-cause mortality within three years after nephrectomy. The functional change ratio (FCR) of eGFR was defined as the ratio of the most recent GFR (24–36 months after surgery) to the new baseline during 3–12 months. A multivariable Cox proportional hazard regression analysis for new-onset CKD and a multivariable linear regression analysis for FCR were performed to evaluate the association between AKI and long-term renal outcomes. A correlation analysis was performed with the serum creatinine ratio and used to determine AKI and FCR. AKI occurred in 43.2% (n = 241/558) and our primary outcome developed in 40.5% (n = 226/558) of patients. The incidence of new-onset CKD was significantly higher in patients with AKI than those without at all follow-up time points after surgery. The Cox regression analysis showed a graded association between AKI and our primary outcome (AKI stage 1: Hazard ratio 1.71, 95% confidence interval 1.25–2.32; AKI stage 2 or 3: Hazard ratio 2.72, 95% confidence interval 1.78–4.10). The linear regression analysis for FCR showed that AKI was significantly associated with FCR (β = −0.168 ± 0.322, p = 0.011). There was a significant negative correlation between the serum creatinine ratio and FCR. In conclusion, our analysis demonstrated a robust and graded association between AKI after radical nephrectomy and long-term renal functional deterioration.

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“…Moreover, a randomized trial demonstrated that sevoflurane reduced the release of cardiac troponin I significantly more than propofol did in patients with coronary artery disease undergoing vascular surgery [20]. However, considering the accumulating evidence indicating the lack of significant benefits of choosing volatile anesthetics over propofol during noncardiac surgery [16,21,[37][38][39], the 2014 ACC/AHA guidelines thus revised the recommendations regarding the choice of anesthetics for noncardiac surgery [26]. Subsequent randomized trials comparing TIVA with sevoflurane also reported no difference in their primary outcomes related to myocardial injury [22,40].…”

Section: Discussionmentioning

confidence: 99%

“…Volatile anesthetics have shown organ-protective effects, including that of the heart [11][12][13]. Propofol has anti-oxidant and anti-inflammatory actions; therefore, it has the potential to attenuate the ischemia-reperfusion injury of major organs [14][15][16]. Since cardiovascular complication after surgery involves sympathetic activation, hypercoagulability, arterial thrombosis, and inflammation [17][18][19], the choice of anesthetics has potential to affect the incidence of MACCE after noncardiac surgery in patients with a history of coronary stent insertion.…”

Section: Introductionmentioning

confidence: 99%

Anesthetic Agents and Cardiovascular Outcomes of Noncardiac Surgery after Coronary Stent Insertion

Yoon¹,

Jun²,

Park³

et al. 2020

JCM

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Patients undergoing noncardiac surgery after coronary stent implantation are at an increased risk of thrombotic complications. Volatile anesthetics are reported to have organ-protective effects against ischemic injury. Propofol has an anti-inflammatory action that can mitigate ischemia-reperfusion injury. However, the association between anesthetic agents and the risk of major adverse cardiovascular and cerebral event (MACCE) has never been studied before. In the present study, a total of 1630 cases were reviewed. Four different propensity score matchings were performed to minimize selection bias (propofol-based total intravenous anesthesia (TIVA) vs. volatile anesthetics; TIVA vs. sevoflurane; TIVA vs. desflurane; and sevoflurane vs. desflurane). The incidence of MACCE in these four propensity score-matched cohorts was compared. As a sensitivity analysis, a multivariable logistic regression analysis was performed to identify independent predictors for MACCE during the postoperative 30 days both in total and matched cohorts (TIVA vs. volatile agent). MACCE occurred in 6.0% of the patients. Before matching, there was a significant difference in the incidence of MACCE between TIVA and sevoflurane groups (TIVA 5.1% vs. sevoflurane 8.2%, p = 0.006). After matching, there was no significant difference in the incidence of MACCE between the groups of any pairs (TIVA 6.5% vs. sevoflurane 7.7%; p = 0.507). The multivariable logistic regression analysis revealed no significant association of the volatile agent with MACCE (odds ratio 1.48, 95% confidence interval 0.92–2.37, p = 0.104). In conclusion, the choice of anesthetic agent for noncardiac surgery did not significantly affect the development of MACCE in patients with previous coronary stent implantation. However, further randomized trials are needed to confirm our results.

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General Anesthetic Agents and Renal Function after Nephrectomy

Cited by 14 publications

References 47 publications

Effects of Anesthetic Technique on the Occurrence of Acute Kidney Injury after Spine Surgery: A Retrospective Cohort Study

Effects of Anesthetic Technique on the Occurrence of Acute Kidney Injury after Spine Surgery: A Retrospective Cohort Study

Robust Association between Acute Kidney Injury after Radical Nephrectomy and Long-term Renal Function

Anesthetic Agents and Cardiovascular Outcomes of Noncardiac Surgery after Coronary Stent Insertion

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