Abstract
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.
Highlights
Kidney cancer, more than 90% of which is renal cell carcinoma (RCC), is common in both men and women [1]
There were significant differences in the incidences of postoperative acute kidney injury (AKI), new-onset chronic kidney disease (CKD) stage 3a or high and CKD upstaging between the propofol and volatile groups. (Tables 2 and 3) there was no significant difference between the sevoflurane and desflurane groups (Table 4)
The propofol group still showed significantly less frequent postoperative AKI, new-onset CKD stage 3a or high, and CKD upstaging than the sevoflurane group (Table 2)
Summary
More than 90% of which is renal cell carcinoma (RCC), is common in both men and women [1]. Partial or radical nephrectomy is the standard treatment for localized RCC [2], postoperative acute kidney injury (AKI) remains a common complication with a risk of evolving chronic kidney disease (CKD) [3,4] and the distant organ dysfunction [5]. Effective interventions to decrease the risk of renal functional decline after nephrectomy are still required [16] As another modifiable risk factor, the choice of general anesthetic agents would be important. There have been no previous reports regarding the effect of general anesthetic agents on the postoperative renal function and it is unknown whether the choice of general anesthetic agents influences the risk of AKI or long-term renal function after partial or radical nephrectomy. Preoperative stage of CKD 1 (eGFR ≥ 90 mL/min/1.73 m2). 5 (< 15 mL/min/1.73 m2) Preoperative proteinuria, n Preoperative hemoglobin, g/dL Preoperative albumin, g/dL ECOG performance status
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