General Anaesthetic Techniques and the Incidence of Acute Kidney Injury: Systematic Review and Meta-analysis

Abstract

Background: Acute kidney injury (AKI) is a critical postoperative complication. This study compares the incidence of AKI in adults undergoing non-cardiac surgery with propofol-based total intravenous anaesthesia (TIVA) versus sevoflurane-based volatile anaesthesia (VA). Methods: A systematic review and meta-analysis of studies from 2000 to 2024 was conducted. The primary outcome was AKI incidence using KDIGO criteria, analyzed with a random-effects model. Secondary outcomes using RIFLE and AKIN criteria were qualitatively synthesized. Results: Seven studies involving 6,795 participants showed a lower AKI incidence in the TIVA group (3.63%) compared to the VA group (6.21%), with a pooled risk ratio of 0.586 (95% CI: 0.332 to 1.036, p = 0.066). Results were not statistically significant, and heterogeneity was high (I² = 73.0%). Conclusion: TIVA may reduce AKI incidence compared to VA, but further studies are needed. Novel biomarkers like NGAL and KIM-1 could improve early AKI detection and management.