Renal injury from sevoflurane in noncardiac surgery: a retrospective cohort study

Sevoflurane is metabolised into Compound A and fluoride that carry a hypothetical risk of nephrotoxicity. However, a clinically significant association between sevoflurane use and acute kidney injury (AKI) in humans has not been established. We retrospectively reviewed 15 552 patients who underwent noncardiac surgery under general anaesthesia using a volatile agent lasting >3 h between July 2016 and May 2019 at a single centre. Patients were divided into a sevoflurane group or no sevoflurane group (desflurane or isoflurane). The primary outcome was incidence of postoperative AKI, which was defined based on the Kidney Disease: Improving Global Outcomes criteria using creatinine concentration within 48 h postoperatively. Propensity score analysis using inverse probability of treatment weighting and propensity score matching was designed to compare outcomes between groups. Amongst 13 701 included patients, 11 070 (80.8%) received sevoflurane during anaesthesia. The incidence of AKI was 2.3% (257/11 070) and 2.5% (66/2631) in the sevoflurane and no sevoflurane groups, respectvely (P=0.57). After inverse probability of treatment weighting adjustment, sevoflurane anaesthesia was not significantly associated with postoperative AKI (odds ratio [OR] 1.32; 95% confidence interval [CI]: 0.99–1.76; P=0.059). In the matched cohort, the incidence of AKI was 3.1% (81/2626) and 2.4% (62/2626) in the sevoflurane and no sevoflurane groups, respectively, and sevoflurane anaesthesia was not associated with postoperative AKI (OR 1.32; 95% CI: 0.94–1.86; P=0.11). Sevoflurane anaesthesia for >3 h was not associated with postoperative renal injury compared with anaesthesia using other volatile agents.