Key result
Sugammadex administration did not significantly affect the 30-day mortality rate compared to non-use in patients with end-stage renal disease undergoing surgery under general anesthesia (OR 0.94).
Why the study?
Data supporting the clinical safety of sugammadex in patients with renal impairment are limited, as clearance of the sugammadex-rocuronium complex depends on renal excretion.
Does sugammadex improve or reduce 30-day mortality in patients with end-stage renal disease undergoing surgery under general anesthesia?
Cohort (n=2,039)
No
Does sugammadex improve or reduce 30-day mortality in patients with end-stage renal disease undergoing surgery under general anesthesia?
Odds Ratio: 0.94 (95% CI 0.55–1.62)
Absolute Event Rate: 3.5% vs 3.5%
p-value: p=0.827
In patients with end-stage renal disease undergoing general anesthesia, the use of sugammadex for neuromuscular blockade reversal does not increase 30-day or 1-year postoperative mortality compared to conventional reversal agents.
Supports sugammadex consideration in ESRD without mortality signal; leaves open confirmation by randomized trials.
BACKGROUND: Clearance of the sugammadex-rocuronium complex is limited to renal excretion. There are restrictions on the use of sugammadex in patients with severe renal impairment. A paucity of data supports the clinical safety of sugammadex in patients with renal impairment. We analyzed mortality after using sugammadex in patients with end-stage renal disease to establish evidence of safety for sugammadex. METHODS: We retrospectively collected the medical records of 2,134 patients with end-stage renal disease who were dependent on hemodialysis and underwent surgery under general anesthesia between January 2018 and December 2019. Propensity score matching was used. The primary outcome was the 30-day mortality rate, and secondary outcomes were the 1-year mortality rate and causes of death. RESULTS: A total of 2,039 patients were included in the study. Sugammadex was administered as a reversal agent for rocuronium in 806 (39.5%) patients; the remaining 1,233 (60.5%) patients did not receive sugammadex. After matching, 1,594 patients were analyzed; 28 (3.5%) of the 797 patients administered sugammadex, and 28 (3.5%) of the 797 patients without sugammadex, died within 30 days after surgery (P > 0.99); 38 (4.8%) of the 797 patients administered sugammadex, and 45 (5.7%) of the 797 patients without sugammadex, died within 1 year after surgery (P = 0.499). No significant differences in the causes of 30-day mortality were observed between the two groups after matching (P = 0.860). CONCLUSIONS: In this retrospective study, sugammadex did not increase the 30-day and 1-year mortality rate after surgery in end-stage renal disease patients.
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Song et al. (2022) conducted a cohort in End-stage renal disease (n=2,039). Sugammadex vs. Non-sugammadex (unexposed) was evaluated on 30-day mortality rate (OR 0.94, 95% CI 0.55-1.62, p=0.827). Sugammadex administration did not significantly affect the 30-day mortality rate compared to non-use in patients with end-stage renal disease undergoing surgery under general anesthesia (OR 0.94).
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