Renal Outcomes in Critically Ill Patients Receiving Propofol or Midazolam.
OBJECTIVE
Propofol has been shown to provide protection against renal ischemia/reperfusion injury experimentally, but clinical evidence is limited to patients undergoing cardiac surgery. There are no data about its association with oliguria and AKI in critically ill patients.


METHODS
We obtained data from the Multiparameter Intelligent Monitoring in Intensive Care II database (2001-2008). Patient selection criteria included adult patients in their first intensive care unit (ICU) admission, need for mechanical ventilation, and treatment with propofol or midazolam. Propensity score analysis (1:1) was used and renal-related outcomes (AKI, oliguria, cumulative fluid balance, and need for RRT) were evaluated during the first 7 days of ICU stay.


RESULTS
There were 1396 propofol/midazolam-matched patients. AKI in the first 7-day ICU time period was statistically lower in propofol-treated patients compared with midazolam-treated patients (55.0% versus 67.3%, P<0.001). Propofol was associated with lower AKI incidence using both urine output (45.0% versus 55.7%, P<0.001) and serum creatinine criteria (28.8% versus 37.2%, P=0.001). Patients receiving propofol had oliguria (<400 ml/d) less frequently (12.4% versus 19.6%, P=0.001) and had diuretics prescribed less often (8.5% versus 14.3%, P=0.001). In addition, during the first 7 days of ICU stay, patients receiving propofol less frequently achieved cumulative fluid balance >5% of body weight (50.1% versus 58.3%, P=0.01). The need for RRT in the first 7 days of ICU stay was also less frequent in propofol-treated patients (3.4% versus 5.9%, P=0.03). ICU mortality was lower in propofol-treated patients (14.6% versus 29.7%, P<0.001).


CONCLUSIONS
In this large, propensity-matched ICU population, patients treated with propofol had a lower risk of AKI, fluid-related complications, and need for RRT.
Medical Sciences Postgraduate Program, Department of Clinical Medicine, Federal University of Ceará, Fortaleza-Ceará, Brazil; and.
Tacyano Tavares
TT
Leite
Department of Nephrology, Clinical Hospital, University of São Paulo, São Paulo, Brazil.
Etienne
E
Macedo
Medical Sciences Postgraduate Program, Department of Clinical Medicine, Federal University of Ceará, Fortaleza-Ceará, Brazil; and.
Izanio da Silva
Ida S
Martins
Medical Sciences Postgraduate Program, Department of Clinical Medicine, Federal University of Ceará, Fortaleza-Ceará, Brazil; and.
Fernanda Macedo de Oliveira
FM
Neves
Medical Sciences Postgraduate Program, Department of Clinical Medicine, Federal University of Ceará, Fortaleza-Ceará, Brazil; and alexandreliborio@yahoo.com.br.
Alexandre Braga
AB
Libório
D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000453:epidemiology; D000368:Aged; D018686:Anesthetics, Intravenous / Q000009:adverse effects*; D015331:Cohort Studies; D016638:Critical Illness; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008874:Midazolam / Q000009:adverse effects*; D008875:Middle Aged; D057216:Propensity Score; D015742:Propofol / Q000009:adverse effects*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
D018686:Anesthetics, Intravenous; D008874:Midazolam; D015742:Propofol
ARF; renal dialysis; renal protection