The effect of different anesthetics on the incidence of AKI and AKD after neurosurgical procedures

Abstract

Acute kidney injury (AKI) incidence after neurosurgical operations has been reported as 10-14%. The literature regarding the incidence of nosocomial acute kidney disease (AKD) following neurosurgery is scarce. This retrospective, single-center, observational study aimed to assess the impact of different anaesthetics on development of postoperative AKI and persistent AKD in neurosurgical patients. We have categorized patients depending by the type of total intravenous anaestesia with propofol or sevoflurane. Most patients (74%) were on total intravenous anesthesia with propofol, while the rest (26%) were on sevoflurane. Patients were divided into subgroups with and without AKD depending on glomerular filtration rate <or> 60 ml/min regarding kidney function at the end of intensive care unit stay. AKI was diagnosed in 341 (5.39%) patients. Significantly higher number of patients developed AKD in the sevoflurane group (16.9% vs. 6.3%). There was a significantly higher number of patients with both high and low AKI stages on sevoflurane and with hypotension during operation. Anaesthesia with sevoflurane had increased OR of 5.09 and ROC value of 0.681 for development of AKI. Anesthesia with sevoflurane had an increased OR of 4.98 and ROC value of 0.781 for development of AKD. Mortality was independently associated with anesthesia with sevoflurane, AKI development, hypotension during operation and AKD. Anesthesia with sevoflurane, hypotension during operation, and the development of AKD at the end of ICU stay were associated with higher mortality in the whole group (HR 6.996, HR 1.924 and HR 4.969, respectively). Patients treated with balanced anesthesia with sevoflurane had more frequent AKI and AKD with shorter survival. Renal toxicity of sevoflurane is pronounced in hypotension during operation and with a history of diabetes and coronary disease.

Fig 1. A patient flowchart.

ICU-intensive care unit; AKI-acute kidney injury.

Fig 2

A and B. The receiver operating characteristics curves show the predictability of sevoflurane for (A) AKI and (B) AKD. AKI-acute kidney injury; AKD-acute kidney disease.