Journal of Anesthesia

, Volume 31, Issue 6, pp 895–902 | Cite as

Effect of remifentanil during cardiopulmonary bypass on incidence of acute kidney injury after cardiac surgery

  • Wataru Sakai
  • Yusuke Yoshikawa
  • Naoyuki Hirata
  • Michiaki Yamakage
Original Article



Acute kidney injury (AKI) after cardiopulmonary bypass (CPB) is a well-known postoperative complication. Remifentanil, which is a commonly used ultra-short-acting opioid, has antiinflammatory and sympatholytic effects with improvement of microcirculation.


A retrospective study was conducted to clarify the effect of the use of remifentanil during CPB on the incidence of postoperative AKI. Patients who underwent valve surgery while under cardiopulmonary bypass between January 2012 and December 2014 in our hospital were enrolled in this study. The incidences of postoperative AKI were compared in patients who received remifentanil during CPB (group R) and those who did not (group N). Univariate and multivariate regression analyses were performed to determine risk factors for AKI.


Eighty patients received remifentanil (group R) and 50 patients did not (group N). The incidences of AKI were not significantly different in group R and group N (51% vs. 36%, P = 0.10). In multivariate regression analysis, age [adjusted odds ratio (OR) 1.048, 95% CI 1.008–1.089, P = 0.017], male gender (adjusted OR 3.101, 95% CI 1.303–7.378, P = 0.011), and use of preoperative calcium channel blockers (adjusted OR 3.240, 95% CI 1.302–8.063, P = 0.011) and diuretics (adjusted OR 2.673, 95% CI 1.178–6.066, P = 0.019) were associated with the incidence of AKI. The use of remifentanil was not associated with AKI (adjusted OR 2.321, 95% CI 0.997–5.402, P = 0.051).


The use of remifentanil during CPB did not decrease the incidence of postoperative AKI after cardiac surgery.


Remifentanil Acute kidney injury Cardiopulmonary bypass 


Compliance with ethical standards

Conflict of interest

None declared.


  1. 1.
    Rosner MH, Okusa MD. Acute kidney injury associated with cardiac surgery. Clin J Am Soc Nephrol. 2006;1:19–32.CrossRefPubMedGoogle Scholar
  2. 2.
    Hu J, Chen R, Liu S, Yu X, Zou J, Ding X. Global incidence and outcomes of adult patients with acute kidney injury after cardiac surgery: a systematic review and meta-analysis. J Cardiothorac Vasc Anesth. 2016;30:82–9.CrossRefPubMedGoogle Scholar
  3. 3.
    Hansen MK, Gammelager H, Jacobsen CJ, Hjortdal VE, Layton JB, Rasmussen BS, Andreasen JJ, Johnsen SP, Christiansen CF. Acute kidney injury and long-term risk of cardiovascular events after cardiac surgery: a population-based cohort study. J Cardiothorac Vasc Anesth. 2015;29:617–25.CrossRefPubMedGoogle Scholar
  4. 4.
    Xu JR, Zhu JM, Jiang J, Ding XQ, Fang Y, Shen B, Liu ZH, Zou JZ, Liu L, Wang CS, Ronco C, Liu H, Teng J. Risk factors for long-term mortality and progressive chronic kidney disease associated with acute kidney injury after cardiac surgery. Medicine (Baltim). 2015;94:e2025.CrossRefGoogle Scholar
  5. 5.
    Karkouti K, Wijeysundera DN, Yau TM, Callum JL, Cheng DC, Crowther M, Dupuis JY, Fremes SE, Kent B, Laflamme C, Lamy A, Legare JF, Mazer CD, McCluskey SA, Rubens FD, Sawchuk C, Beattie WS. Acute kidney injury after cardiac surgery: focus on modifiable risk factors. Circulation. 2009;119:495–502.CrossRefPubMedGoogle Scholar
  6. 6.
    Lassnigg A, Schmidlin D, Mouhieddine M, Bachmann LM, Druml W, Bauer P, Hiesmayr M. Minimal changes of serum creatinine predict prognosis in patients after cardiothoracic surgery: a prospective cohort study. J Am Soc Nephrol. 2004;15:1597–605.CrossRefPubMedGoogle Scholar
  7. 7.
    Kumar AB, Suneja M. Cardiopulmonary bypass-associated acute kidney injury. Anesthesiology. 2011;114:964–70.CrossRefPubMedGoogle Scholar
  8. 8.
    Myles PS, Hunt JO, Fletcher H, Watts J, Bain D, Silvers A, Buckland MR. Remifentanil, fentanyl, and cardiac surgery: a double-blinded, randomized, controlled trial of costs and outcomes. Anesth Analg. 2002;95:805–12.PubMedGoogle Scholar
  9. 9.
    Winterhalter M, Brandl K, Rahe-Meyer N, Osthaus A, Hecker H, Hagl C, Adams HA, Piepenbrock S. Endocrine stress response and inflammatory activation during CABG surgery. A randomized trial comparing remifentanil infusion to intermittent fentanyl. Eur J Anaesthesiol. 2008;25:326–35.CrossRefPubMedGoogle Scholar
  10. 10.
    Ouattara A, Boccara G, Köckler U, Lecomte P, Leprince P, Léger P, Riou B, Rama A, Coriat P. Remifentanil induces systemic arterial vasodilation in humans with total artificial heart. Anesthesiology. 2004;100:602–7.CrossRefPubMedGoogle Scholar
  11. 11.
    De Blasi RA, Palmisani S, Boezi M, Arcioni R, Collini S, Troisi F, Pinto G. Effects of remifentanil-based general anaesthesia with propofol or sevoflurane on muscle microcirculation as assessed by near-infrared spectroscopy. Br J Anaesth. 2008;101:171–7.CrossRefPubMedGoogle Scholar
  12. 12.
    Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, Levin A, Acute Kidney Injury Network. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care. 2007;11:R31.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Demir A, Yılmaz FM, Ceylan C, Doluoglu OG, Uçar P, Züngün C, Guclu CY, Ünal U, Karadeniz U, Günertem E, Lafci G, Çağlı K, Özgök A. A comparison of the effects of ketamine and remifentanil on renal functions in coronary artery bypass graft surgery. Ren Fail. 2015;37:819–26.CrossRefPubMedGoogle Scholar
  14. 14.
    Thakar CV, Arrigain S, Worley S, Yared JP, Paganini EP. A clinical score to predict acute renal failure after cardiac surgery. J Am Soc Nephrol. 2005;16:162–8.CrossRefPubMedGoogle Scholar
  15. 15.
    Carrel T, Englberger L, Mohacsi P, Neidhart P, Schmidli J. Low systemic vascular resistance after cardiopulmonary bypass: incidence, etiology, and clinical importance. J Card Surg. 2000;15:347–53.CrossRefPubMedGoogle Scholar
  16. 16.
    Philbin DM, Coggins CH, Wilson N, Sokoloski J. Antidiuretic hormone levels during cardiopulmonary bypass. J Thorac Cardiovasc Surg. 1977;73:145–8.PubMedGoogle Scholar
  17. 17.
    Edwards RM, Trizna W, Kinter LB. Renal microvascular effects of vasopressin and vasopressin antagonists. Am J Physiol. 1989;256:F274–8.PubMedGoogle Scholar
  18. 18.
    Watanabe K, Kashiwagi K, Kamiyama T, Yamamoto M, Fukunaga M, Inada E, Kamiyama Y. High-dose remifentanil suppresses stress response associated with pneumoperitoneum during laparoscopic colectomy. J Anesth. 2014;28:334–40.CrossRefPubMedGoogle Scholar
  19. 19.
    Ng RR, Chew ST, Liu W, Shen L, Ti LK. Identification of modifiable risk factors for acute kidney injury after coronary artery bypass graft surgery in an Asian population. J Thorac Cardiovasc Surg. 2014;147:1356–61.CrossRefPubMedGoogle Scholar
  20. 20.
    Parolari A, Pesce LL, Pacini D, Mazzanti V, Salis S, Sciacovelli C, Rossi F, Alamanni F, Monzino Research Group on Cardiac Surgery Outcomes. Risk factors for perioperative acute kidney injury after adult cardiac surgery: role of perioperative management. Ann Thorac Surg. 2012;93:584–91.CrossRefPubMedGoogle Scholar
  21. 21.
    Benstein JA, Dworkin LD. Renal vascular effects of calcium channel blockers in hypertension. Am J Hypertens. 1990;3:305S–12S.CrossRefPubMedGoogle Scholar
  22. 22.
    Amano J, Suzuki A, Sunamori M, Tofukuji M. Effect of calcium antagonist diltiazem on renal function in open heart surgery. Chest. 1995;107:1260–5.CrossRefPubMedGoogle Scholar
  23. 23.
    Young EW, Diab A, Kirsh MM. Intravenous diltiazem and acute renal failure after cardiac operations. Ann Thorac Surg. 1998;65:1316–9.CrossRefPubMedGoogle Scholar
  24. 24.
    Hayashi K, Wakino S, Sugano N, Ozawa Y, Homma K, Saruta T. Ca2+ channel subtypes and pharmacology in the kidney. Circ Res. 2007;100:342–53.CrossRefPubMedGoogle Scholar
  25. 25.
    Wu X, Zhang W, Ren H, Chen X, Xie J, Chen N. Diuretics associated acute kidney injury: clinical and pathological analysis. Ren Fail. 2014;36:1051–5.CrossRefPubMedGoogle Scholar
  26. 26.
    James MK, Vuong A, Grizzle MK, Schuster SV, Shaffer JE. Hemodynamic effects of GI 87084B, an ultra-short acting mu-opioid analgesic, in anesthetized dogs. J Pharmacol Exp Ther. 1992;263:84–91.PubMedGoogle Scholar

Copyright information

© Japanese Society of Anesthesiologists 2017

Authors and Affiliations

  1. 1.Department of AnesthesiologyAsahikawa City HospitalAsahikawaJapan
  2. 2.Department of AnesthesiologySapporo Medical University HospitalSapporoJapan

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