title: Remifentanil temporarily improves renal function in adult patients with chronic kidney disease undergoing orthopedic surgery.
abstract: OBJECTIVE
  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.
authors: Department of Anesthesiology and Critical Care Medicine, Functional Biology and Pharmacology, Advanced Therapeutics Course, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, Japan. terashi@m2.kufm.kagoshima-u.ac.jp
authors: Takerou
authors: T
authors: Terashi
authors: Akihiko
authors: A
authors: Takehara
authors: Tamotsu
authors: T
authors: Kuniyoshi
authors: Akira
authors: A
authors: Matsunaga
authors: Kouichi
authors: K
authors: Kawasaki
authors: Yuuichi
authors: Y
authors: Kanmura
mesh_terms: D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000768:Anesthesia, General / Q000379:methods; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007668:Kidney / Q000187:drug effects*; D008297:Male; D019637:Orthopedic Procedures / Q000379:methods; D010880:Piperidines / Q000008:administration & dosage*; D000077208:Remifentanil; D006435:Renal Dialysis / Q000379:methods; D051436:Renal Insufficiency, Chronic / Q000188:drug therapy* / Q000601:surgery*; D012189:Retrospective Studies
chemical_list: D000701:Analgesics, Opioid; D010880:Piperidines; D000077208:Remifentanil