Anaesthesia, Год журнала: 2024, Номер 79(12), С. 1379 - 1380

Опубликована: Авг. 11, 2024

We read with interest the article by Choi et al., which examines association between acute kidney injury in patients who have had their angiotensin-converting enzyme inhibitors or angiotensin receptor-blocking drugs withheld continued, respectively, pre-operatively [1]. commend them on a well-designed study that paid great attention to relevant propensity matching. want comment difference statistical significance and clinical relevance [2]. While we agree an increase of 26.4 μmol.l-1 < 48 h is definition as set out Acute Kidney Injury Network, both groups show increased serum creatinine values postoperative period [1, 3]. The actual relatively small two groups, would lead us question significance. In contrast, those breach threshold clear undeniable. As discussed article, recent meta-analysis Hollmann al. failed peri-operative administration mortality major adverse cardiac events undergoing non-cardiac surgery [3]. supports routine withholding pre-operatively, think more interesting whether can identify specific subsets are significantly impacted continuation these period. This addressed supplementary material where see odds ratio developing appears be much greater present for elevated baseline creatinine, low haemoglobin, BMI requiring pre-operative red blood cell transfusion. interested if authors, knowing data detail, any opinion they need cancel higher-risk cohort erroneously continue peri-operatively. authors report was associated mean reduction intra-operative arterial pressure 1.3 mmHg. this has reached significance, again, its relevance. medications also large levels pressure, fluid boluses vasopressor statistically significant but, highlight type maintenance anaesthesia (volatile, total intravenous even neuraxial techniques), sex patient could potentially contribute renal dysfunction. However, there were male enrolled (58%), received volatile anaesthetic (75%) no groups. Oh et. performed retrospective score analysis showing injuries sevoflurane-based inhalational [4]. raises variables clinically enough mentioned study. primary outcome important addition literature, poses questions. Is key effect not seen because including cohorts functional reserve? If further dissected look at impact values, may find true lies.

Язык: Английский