Sugammadex use in patients with end-stage renal disease: a historical cohort study

Abstract

Purpose While sugammadex (SGX) is not approved for use in patients with end-stage renal disease (ESRD), its administration in this patient population has been reported. We designed the current study to review all instances of patients with ESRD receiving SGX and to describe their clinical outcomes. Methods This is a historical cohort study of 219 patients with chronic kidney disease stage 5 who received SGX in one of three hospital locations within the same academic health system. Data were collected between 7 March 2016 and 1 August 2019 and included demographics, notable events from the anesthesia records, and postoperative complications. The primary outcome included any complication possibly related to SGX such as hypersensitivity reactions, need for reintubation, hypoxemia, pneumonia, and residual neuromuscular blockade. Secondary outcomes included any other complication not included in the primary outcome and/or patient mortality within 30 days after the procedure. Results No patient experienced a hypersensitivity reaction. Three patients required reintubation while two patients developed hypoxemia that did not require reintubation. One patient developed hospital-acquired pneumonia. Fifty (23%) patients developed other

Efficacy and Safety of Sugammadex for the Reversal of Rocuronium-Induced Neuromuscular Blockade in Patients with End-Stage Renal Disease: A Systematic Review and Meta-Analysis

“…This suggests that there is a very slim possibility of NMB recurrence after sugammadex injection in patients with ESRD. Paredes et al [16] demonstrated that nine cases out of 219 patients (4.1%) were re-intubated, and of these, three (1.4%) patients were not excluded because of the possibility of sugammadex-related residual NMB. However, there was no mortality associated with sugammadex.…”

“…Therefore, the number of clinical studies reported to date is limited [2,[11][12][13][14][15], and only a few case reports have been reported [8,18,19]. Nevertheless, the demand and need for the administration of rocuronium and sugammadex in ESRD patients in actual clinical practice is increasing, and several recently reported retrospective studies dispute this need [6,7,16,20]. Therefore, considering that there is an increasing need to evaluate the efficacy and safety of sugammadex in patients with ESRD, we tried, systematically and closely, to examine the efficacy and safety of the administration of rocuronium and sugammadex in ESRD patients, using a systematic review framework as far as this is possible.…”

Sugammadex in end-stage renal disease: too early for a “free-pass”

“…We read with interest the retrospective study by Paredes et al evaluating the outcomes in an end-stage renal disease (ESRD) cohort receiving sugammadex (SGX). 1 The outcomes (complications) they evaluated need further comment and clarification.…”

“…The authors included hypersensitivity reactions, reintubation, hypoxemia, and pneumonia as the primary postoperative complications. 1 Nevertheless, they did not consider other well-recognized drug-related cardiac adverse effects such as bradycardia, particularly relevant in ESRD settings prone to hyperkalemia-induced conduction disturbances. 2,3 In addition, reports of thirddegree heart block, asystole, hypotension, coronary vasospasm, and cardiac arrest with SGX also warrant caution.…”

“…Despite the explanation put forth in support of there being little significance to the neuromuscular blocking agent (NMBA) dissociation from the prolonged exposure to SGX-NMBA complexes in ESRD, the authors cannot completely exclude the possibility of residual neuromuscular blockade in the absence of universal quantitative neuromuscular monitoring, particularly across the range of SGX doses employed. 1,4 Moreover, circulatory shock (highlighted as a cause of primary complication) can itself hamper the SGX-NMBA complex clearance. In addition, their citation of volume-overload as the cause of postoperative hypoxemia is also far from objective.…”