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.