Future Directions in Optimizing Anesthesia to Reduce Perioperative Acute Kidney Injury.

Bin Zeng, Yinuo Liu, Jiawei Xu, Liyan Niu, Yuting Wu, Deju Zhang, Xiaoyi Tang, Zicheng Zhu, Yixuan Chen, Leilei Hu, Shuchun Yu, Peng Yu, Jing Zhang, Wenting Wang

Journal: American journal of nephrology 2023;54(9-10):434-450

PMID: 37742618

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Abstract

BACKGROUND

Perioperative acute kidney injury (AKI) is common in surgical patients and is associated with high morbidity and mortality. There are currently few options for AKI prevention and treatment. Due to its complex pathophysiology, there is no efficient medication therapy to stop the onset of the injury or repair the damage already done. Certain anesthetics, however, have been demonstrated to affect the risk of perioperative AKI in some studies. The impact of anesthetics on renal function is particularly important as it is closely related to the prognosis of patients. Some anesthetics can induce anti-inflammatory, anti-necrotic, and anti-apoptotic effects. Propofol, sevoflurane, and dexmedetomidine are a few examples of anesthetics that have protective association with AKI in the perioperative period.

SUMMARY

In this study, we reviewed the clinical characteristics, risk factors, and pathogenesis of AKI. Subsequently, the protective effects of various anesthetic agents against perioperative AKI and the latest research are introduced.

KEY MESSAGE

This work demonstrates that a thorough understanding of the reciprocal effects of anesthetic drugs and AKI is crucial for safe perioperative care and prognosis of patients. However, more complete mechanisms and pathophysiological processes still need to be further studied.

Address: Department of Gastroenterology, First Affiliated Hospital of Gannan Medical University, Ganzhou, China.; Department of Metabolism and Endocrinology, The Second Affiliated Hospital of Nanchang University, Nanchang, China, [email protected].; The Second Clinical Medical College of Nanchang University, Nanchang, China, [email protected].; Department of Metabolism and Endocrinology, The Second Affiliated Hospital of Nanchang University, Nanchang, China.; The Second Clinical Medical College of Nanchang University, Nanchang, China.; Department of Metabolism and Endocrinology, The Second Affiliated Hospital of Nanchang University, Nanchang, China.; The Second Clinical Medical College of Nanchang University, Nanchang, China.; Huan Kui College, Nanchang University, Nanchang, China.; Huan Kui College, Nanchang University, Nanchang, China.; Department of Metabolism and Endocrinology, The Second Affiliated Hospital of Nanchang University, Nanchang, China.; Huan Kui College, Nanchang University, Nanchang, China.; Food and Nutritional Sciences, School of Biological Sciences, The University of Hong Kong, Hong Kong, Hong Kong, China.; Department of Anesthesiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China.; Department of Metabolism and Endocrinology, The Second Affiliated Hospital of Nanchang University, Nanchang, China.; Department of Anesthesiology, The Second Affiliated Hospital of Hainan Medical University, Haikou, China.; Department of Cardiopulmonary Bypass, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

DOI: 10.1159/000533534

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MeSH Terms: Humans, Acute Kidney Injury, Anesthesia, Propofol, Anesthetics, Sevoflurane