Comparison of ephedrine and phenylephrine use on postoperative acute kidney injury in elective noncardiac surgery: A retrospective cohort study

초록

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) mu g 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 mu g/kg. Conclusion: Intraoperative phenylephrine was associated with a higher risk of developing postoperative AKI than ephedrine in patients who underwent noncardiac surgery.

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