Postoperative acute kidney injury after volatile or intravenous anesthesia: a meta-analysis

Abstract

Postoperative acute kidney injury (AKI) is a common complication after surgery. The pathophysiology of postoperative AKI is complex. One potentially important factor is anesthetic modality. We therefore conducted a meta-analysis of the available literature regarding anesthetic modality and incidence of postoperative AKI. Records were retrieved until January 17, 2023, with the search terms ("propofol" OR "intravenous") AND ("sevoflurane" OR "desflurane" OR "isoflurane" OR "volatile" OR "inhalational") AND ("acute kidney injury" OR "AKI"). A meta-analysis for common effects and random effects was performed after exclusion assessment. Eight records were included in the meta-analysis with a total of 15,140 patients (n=7,542 propofol and n=7,598 volatile). The common and random effects model revealed that propofol is associated with a lower incidence of postoperative AKI in comparison with volatile anesthesia (odds ratio 0.63 [95%CI: 0.56-0.72] and 0.49 [95%CI: 0.33-0.73] respectively). In conclusion, the meta-analysis reveals that propofol anesthesia is associated with a lower incidence of postoperative AKI compared with volatile anesthesia. This may motivate choosing propofol-based anesthesia in patients with increased risk of postoperative AKI due to preexisting renal impairment or a surgery with high risk of renal ischemia.