Purpose: The objective of this study was to confirm the renal protective effect of remifentanil-based anesthesia in perioperative adult patients with chronic kidney disease (CKD).
Methods: A total of 90 non-dialysis perioperative adult patients with CKD, with preoperative estimated glomerular filtration rate from creatinine (eGFRcreat) values of lower than 50 ml/min/1.73 m(2), who had undergone orthopedic surgery under general anesthesia were retrospectively selected. The subjects were divided into two groups according to whether or not remifentanil was used for anesthesia management: group R, in which remifentanil was used for anesthesia management (n = 45), and group NR, in which remifentanil was not used for anesthesia (n = 45). eGFRcreat was measured pre-surgery (pre), 7 days after surgery (day-7), and 14 days after surgery (day-14).
Results: In group R, both day-7 eGFRcreat (52.2 ± 17.0 ml/min/1.73 m(2)) and day-14 eGFRcreat (49.7 ± 15.5 ml/min/1.73 m(2)) were significantly higher than the pre eGFRcreat (40.7 ± 7.5 ml/min/1.73 m(2)) (day-7: p < 0.01; day-14: p < 0.01). In group NR, on the other hand, pre eGFRcreat (37.8 ± 7.6 ml/min/1.73 m(2)), day-7 eGFRcreat (41.2 ± 10.9 ml/min/1.73 m(2)), and day-14 eGFRcreat (40.2 ± 10.5 ml/min/1.73 m(2)) values were similar. Furthermore, both day-7 eGFRcreat and day-14 eGFRcreat were significantly higher in group R than in group NR (day-7: p < 0.01; day-14: p < 0.01).
Conclusions: Our findings suggest that anesthesia management using remifentanil may have a renal protective effect in perioperative adult CKD patients undergoing orthopedic surgery.