Intraoperative phenylephrine was associated with higher odds of postoperative acute kidney injury compared to ephedrine in elective noncardiac surgery (OR 1.27; 95% CI 1.09-1.47; P=0.002).
Does phenylephrine compared to ephedrine increase the risk of postoperative acute kidney injury in adult patients undergoing elective noncardiac surgery?
In patients undergoing elective noncardiac surgery, treating intraoperative hypotension with phenylephrine boluses is associated with a higher risk of postoperative acute kidney injury compared to ephedrine.
Tasa de eventos absoluta: 0% vs 0%
BACKGROUND Intraoperative hypotension is associated with adverse outcomes, such as acute kidney injury (AKI). Phenylephrine and ephedrine are vasopressors commonly used to treat intraoperative hypotension; however, their comparative association with postoperative AKI in non-cardiac surgery patients remains unclear. METHODS We conducted a retrospective cohort study of 45,144 adult patients who underwent elective noncardiac surgery under general anesthesia at a single tertiary center between January 2011 and December 2024. The primary exposure was the type of vasopressor administered as a bolus-ephedrine versus phenylephrine-to treat intraoperative hypotension. The primary outcome was AKI within 7 days postoperatively. We used multivariable logistic regression, adjusting for demographic, comorbidities, laboratory, surgical, and intraoperative variables, to estimate odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS Among the included patients, 40,842 (90.5%) received intraoperative ephedrine, and 4302 (9.5%) received phenylephrine. The median dose (interquartile range) administered intraoperatively was 5 (5-10) mg in the ephedrine group and 60 (40-130) μg in the phenylephrine group. The overall incidence of postoperative AKI was 1751/45,144 (3.9%). A multivariable logistic regression analysis showed that intraoperative phenylephrine use, compared to ephedrine, was associated with higher odds of postoperative AKI (OR, 1.27; 95% CI: 1.09-1.47; P = 0.002). In the dose-response analysis, a nonlinear pattern with a ceiling effect was observed in the odds of postoperative AKI as the phenylephrine dose increased, plateauing at approximately 1.0 μg/kg. CONCLUSION Intraoperative phenylephrine was associated with a higher risk of developing postoperative AKI than ephedrine in patients who underwent noncardiac surgery.
Oh et al. (Mon,) reported a other. Intraoperative phenylephrine was associated with higher odds of postoperative acute kidney injury compared to ephedrine in elective noncardiac surgery (OR 1.27; 95% CI 1.09-1.47; P=0.002).