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General Anesthetic Agents and Renal Function after Nephrectomy
The association between the choice of general anesthetic agents and the risk of acute kidney injury (AKI) and long-term renal dysfunction after nephrectomy has not yet been evaluated. We reviewed 1087 cases of partial or radical nephrectomy. The incidence of postoperative AKI, new-onset chronic kidn...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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MDPI
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6832234/ https://www.ncbi.nlm.nih.gov/pubmed/31554223 http://dx.doi.org/10.3390/jcm8101530 |
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author | Lee, Ho-Jin Bae, Jinyoung Kwon, Yongsuk Jang, Hwan Suk Yoo, Seokha Jeong, Chang Wook Kim, Jin-Tae Kim, Won Ho |
author_facet | Lee, Ho-Jin Bae, Jinyoung Kwon, Yongsuk Jang, Hwan Suk Yoo, Seokha Jeong, Chang Wook Kim, Jin-Tae Kim, Won Ho |
author_sort | Lee, Ho-Jin |
collection | PubMed |
description | The association between the choice of general anesthetic agents and the risk of acute kidney injury (AKI) and long-term renal dysfunction after nephrectomy has not yet been evaluated. We reviewed 1087 cases of partial or radical nephrectomy. The incidence of postoperative AKI, new-onset chronic kidney disease (CKD) and CKD upstaging were compared between general anesthetic agent groups (propofol, sevoflurane, and desflurane). Four different propensity score analyses were performed to minimize confounding for each pair of comparison (propofol vs. sevoflurane; propofol vs. desflurane; sevoflurane vs. desflurane; propofol vs. volatile agents). Study outcomes were compared before and after matching. Kaplan-Meier survival curve analysis was performed to compare renal survival determined by the development of new-onset CKD between groups up to 36 months after nephrectomy. Propofol was associated with a lower incidence of AKI (propofol 23.2% vs. sevoflurane 39.5%, p = 0.004; vs. propofol 21.0% vs. desflurane 34.3%, p = 0.031), a lower incidence of CKD upstaging (propofol 27.2% vs. sevoflurane 58.4%, p < 0.001; propofol 32.4% vs. desflurane 48.6%, p = 0.017) and better three-year renal survival after nephrectomy compared to sevoflurane or desflurane group (Log-rank test propofol vs. sevoflurane p < 0.001; vs. desflurane p = 0.015) after matching. Propofol was also associated with a lower incidence of new-onset CKD after nephrectomy compared to sevoflurane after matching (p < 0.001). There were no significant differences between sevoflurane and desflurane. However, subgroup analysis of partial nephrectomy showed a significant difference only in CKD upstaging. In conclusion, propofol, compared to volatile agents, could be a better general anesthetic agent for nephrectomy to attenuate postoperative renal dysfunction. However, limitations of the retrospective study design and inconsistent results of the subgroup analysis preclude firm conclusions. |
format | Online Article Text |
id | pubmed-6832234 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-68322342019-11-21 General Anesthetic Agents and Renal Function after Nephrectomy Lee, Ho-Jin Bae, Jinyoung Kwon, Yongsuk Jang, Hwan Suk Yoo, Seokha Jeong, Chang Wook Kim, Jin-Tae Kim, Won Ho J Clin Med Article The association between the choice of general anesthetic agents and the risk of acute kidney injury (AKI) and long-term renal dysfunction after nephrectomy has not yet been evaluated. We reviewed 1087 cases of partial or radical nephrectomy. The incidence of postoperative AKI, new-onset chronic kidney disease (CKD) and CKD upstaging were compared between general anesthetic agent groups (propofol, sevoflurane, and desflurane). Four different propensity score analyses were performed to minimize confounding for each pair of comparison (propofol vs. sevoflurane; propofol vs. desflurane; sevoflurane vs. desflurane; propofol vs. volatile agents). Study outcomes were compared before and after matching. Kaplan-Meier survival curve analysis was performed to compare renal survival determined by the development of new-onset CKD between groups up to 36 months after nephrectomy. Propofol was associated with a lower incidence of AKI (propofol 23.2% vs. sevoflurane 39.5%, p = 0.004; vs. propofol 21.0% vs. desflurane 34.3%, p = 0.031), a lower incidence of CKD upstaging (propofol 27.2% vs. sevoflurane 58.4%, p < 0.001; propofol 32.4% vs. desflurane 48.6%, p = 0.017) and better three-year renal survival after nephrectomy compared to sevoflurane or desflurane group (Log-rank test propofol vs. sevoflurane p < 0.001; vs. desflurane p = 0.015) after matching. Propofol was also associated with a lower incidence of new-onset CKD after nephrectomy compared to sevoflurane after matching (p < 0.001). There were no significant differences between sevoflurane and desflurane. However, subgroup analysis of partial nephrectomy showed a significant difference only in CKD upstaging. In conclusion, propofol, compared to volatile agents, could be a better general anesthetic agent for nephrectomy to attenuate postoperative renal dysfunction. However, limitations of the retrospective study design and inconsistent results of the subgroup analysis preclude firm conclusions. MDPI 2019-09-24 /pmc/articles/PMC6832234/ /pubmed/31554223 http://dx.doi.org/10.3390/jcm8101530 Text en © 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Lee, Ho-Jin Bae, Jinyoung Kwon, Yongsuk Jang, Hwan Suk Yoo, Seokha Jeong, Chang Wook Kim, Jin-Tae Kim, Won Ho General Anesthetic Agents and Renal Function after Nephrectomy |
title | General Anesthetic Agents and Renal Function after Nephrectomy |
title_full | General Anesthetic Agents and Renal Function after Nephrectomy |
title_fullStr | General Anesthetic Agents and Renal Function after Nephrectomy |
title_full_unstemmed | General Anesthetic Agents and Renal Function after Nephrectomy |
title_short | General Anesthetic Agents and Renal Function after Nephrectomy |
title_sort | general anesthetic agents and renal function after nephrectomy |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6832234/ https://www.ncbi.nlm.nih.gov/pubmed/31554223 http://dx.doi.org/10.3390/jcm8101530 |
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