Perioperative administration of enoximone and renal function after cardiac surgery: a propensity-matched analysis.
BACKGROUND
Perioperative administration of enoximone has been shown to improve hemodynamics, organ function, and inflammatory response. Aim of the present study is to evaluate the impact of enoximone on postoperative renal function after on-pump cardiac surgery.


METHODS
A total of 3727 patients undergoing cardiac surgery at one Institution between May 2004 and November 2010 were reviewed. A propensity score was built and a 1:1 perfect matching was performed, providing two fairly comparable cohorts of 712 patients each, receiving or not enoximone after surgery. Renal function was evaluated by lower glomerular filtration rate (GFR) value reached postoperatively.


RESULTS
Overall 30-day mortality rate was 4.3% (62/1424). Cumulative incidence of postoperative renal failure (RF) was 157/1424(11%), of which 99/1424(7%) needed renal replacement therapy. Mean lower postoperative GFR in patients who received or not enoximone was 63 ± 30.1 and 53.5 ± 26.1 ml/min/1.73 m(2) (p<0.0001), respectively. At multivariable analysis age (OR2.75, p=0.0004), diabetes (OR1.82, p=0.006), preoperative GFR (OR3.81, p<0.0001), preoperative cardiogenic shock (OR1.65, p=0.004), previous cardiac surgery (OR2.12, p=0.0002), type of intervention (OR1.96, p=0.005), and enoximone (OR0.38, p=0.001) were found to be independently associated with postoperative RF. Logistic regression analysis showed that the administration of enoximone (OR0.41, p=0.0001), and of no inotropes (OR0.27, p<0.0001) were protective vs. the occurrence of postoperative RF.


CONCLUSIONS
Patients perioperatively receiving enoximone showed a statistically significant better renal function after cardiac surgery.
Sapienza, University of Rome, Policlinico Sant'Andrea, Department of Cardiac Surgery, Rome, Italy. emilianoangeloni@gmail.com
Emiliano
E
Angeloni
Giovanni
G
Melina
Antonino
A
Roscitano
Simone
S
Refice
Fabio
F
Capuano
Cosimo
C
Comito
Umberto
U
Benedetto
Riccardo
R
Sinatra
D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality* / Q000639:trends; D015331:Cohort Studies; D017335:Enoximone / Q000008:administration & dosage*; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects / Q000502:physiology*; D006801:Humans; D007668:Kidney / Q000187:drug effects / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods*; D057216:Propensity Score; D012189:Retrospective Studies; D014665:Vasodilator Agents / Q000008:administration & dosage
D014665:Vasodilator Agents; D017335:Enoximone