Preprint Article Version 1 Preserved in Portico This version is not peer-reviewed

General Anesthetic Agents and Renal Function after Nephrectomy

Ho-Jin Lee
ORCID logo ,
Jinyoung Bae
,
Yongsuk Kwon
,
Hwan Suk Jang
,
Seokha Yoo
ORCID logo ,
Chang Wook Jeong
,
Jin-Tae Kim
,
Won Ho Kim
*
Version 1 : Received: 18 August 2019 / Approved: 19 August 2019 / Online: 19 August 2019 (03:47:48 CEST)

A peer-reviewed article of this Preprint also exists.

Lee, H.-J.; Bae, J.; Kwon, Y.; Jang, H.S.; Yoo, S.; Jeong, C.W.; Kim, J.-T.; Kim, W.H. General Anesthetic Agents and Renal Function after Nephrectomy. J. Clin. Med. 2019, 8, 1530. Lee, H.-J.; Bae, J.; Kwon, Y.; Jang, H.S.; Yoo, S.; Jeong, C.W.; Kim, J.-T.; Kim, W.H. General Anesthetic Agents and Renal Function after Nephrectomy. J. Clin. Med. 2019, 8, 1530.

Abstract

The association between the choice of general anesthetic agents and the risk of acute kidney injury (AKI) and long-term renal function 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) stage 3a and CKD upstaging were compared between different 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 CKD stage 3a between groups up to 36 months after nephrectomy before and after matching. Propofol was associated with a lower incidence of AKI, CKD upstaging and a higher three-year renal survival after nephrectomy compared to sevoflurane or desflurane group after matching (AKI: propofol 23.2% vs. sevoflurane 39.5%, P=0.004, vs. desflurane 34.3%, P=0.031; CKD upstaging: propofol 27.2% vs. sevoflurane 58.4%, P<0.001, vs. desflurane 48.6%, P=0.017; Log-rank test propofol vs. sevoflurane P<0.001, vs. desflurane P=0.015). Propofol was also associated with a lower incidence of new-onset CKD after nephrectomy compared to sevoflurane after matching (P<0.001). However, there were no significant differences between sevoflurane and desflurane. In conclusion, propofol, compared to volatile agents, may be the reasonable choice of general anesthetic agent for nephrectomy to attenuate postoperative renal dysfunction. Randomized prospective trials are warranted to test this hypothesis.

Keywords

nephrectomy; acute kidney injury; chronic kidney disease; sevoflurane; desflurane; propofol

Subject

Medicine and Pharmacology, Urology and Nephrology

Copyright: This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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