Comparative effects of sevoflurane and desflurane on postoperative renal function in patients with type 2 Diabetes mellitus.

Background

Although sevoflurane is widely used for general anesthesia, its potential nephrotoxicity remains a concern, particularly in patients with type 2 diabetes mellitus (T2DM). This study compared the renal effects of sevoflurane and desflurane in T2DM patients, focusing on renal cortical fat fraction (RCFF) from preoperative magnetic resonance imaging (MRI).

Methods

In this retrospective cohort study, adult T2DM patients who underwent non-cardiac surgery >3 h under sevoflurane or desflurane anesthesia were included if they had preoperative abdominal MRI with proton density fat fraction sequences. The primary outcome was a sustained decline in estimated glomerular filtration rate (eGFR), defined as a ≥ 25% decrease from baseline persisting through postoperative day 7. Propensity score matching (PSM) was performed to minimize confounding, and multivariate logistic regression was used to identify predictors of eGFR decline.

Results

A total of 158 patients were analyzed after PSM. Overall, 91/158 (57.6%) experienced a sustained decline in eGFR. The incidence did not differ significantly between groups: 50/79 (63.3%) in the sevoflurane group vs. 41/79 (51.9%) in the desflurane group (p = 0.198). In subgroup analysis, lower preoperative eGFR and RCFF were independent predictors of eGFR decline only in the sevoflurane group. An RCFF threshold of 2% identified increased risk; patients with RCFF <2% had a higher rate of eGFR decline under sevoflurane (81.8% vs. 53.3%, p = 0.040), but not under desflurane.

Conclusion

T2DM patients with low RCFF (<2%) may be more susceptible to postoperative renal dysfunction following sevoflurane anesthesia. Further studies are needed to confirm this association.