Volatile anesthetics in preventing acute kidney injury after cardiac surgery: A systematic review and meta-analysis

Abstract

Acute kidney injury is a common clinical complication of cardiac surgery. Volatile anesthetics have been shown to protect against it in animal experiments. Clinically, however, the effect of volatile anesthetics has been unclear. We conducted a systematic review and meta-analysis of randomized, controlled trials to explore whether volatile anesthetics could provide renal protection to patients undergoing cardiac surgery. Randomized, controlled trials were identified in PubMed, Ovid, Excerpta Medica Database, Cochrane Library, Current Controlled Trials Register, reviews, and reference lists of relevant articles. Ten trials with 1600 total participants were eligible. Data were analyzed with both fixed- and random-effects models. Relative to control data, volatile anesthetics significantly reduced acute kidney injury incidence (relative risk [RR], 0.65; 95% confidence interval [CI], 0.43-0.97; P = .04). Although there was no significant difference between groups in absolute postoperative serum creatinine level and mortality, patients receiving volatile anesthetics had significantly (or borderline) lower increase in serum creatinine level from baseline on the first (weighted mean difference, -0.04 mg/dL; 95% CI, -0.07 to -0.01 mg/dL; P = .002) and second (weighted mean difference, -0.07 mg/dL, 95% CI, -0.14 to -0.00 mg/dL; P = .05) postoperative days and reduced incidences of prolonged intensive care unit stay (RR, 0.46; 95% CI, 0.34-0.64; P < .001) and hospitalization (RR, 0.47; 95% CI, 0.27-0.83; P = .009). Current evidence shows that volatile anesthetics may provide renal protection in patients undergoing cardiac surgery and supports further randomized, controlled trials with larger sample sizes and high methodologic quality.