WOULD YOU USE SUGAMMADEX IN PATIENTS WITH END-STAGE RENAL DISEASE?

Our FSA members, Steven B. Porter, MD and J. Ross Renew, MD, published a study titled, “Sugammadex use in patients with end-stage renal disease: a historical cohort study,” sparking discussions as sugammadex (SGX) is not approved for use in patients with end-stage renal disease (ESRD).

The original idea for the study was a result of the authors observing the administration of SGX to patients with ESRD at Mayo Clinic in Florida, despite the off-label usage. As such, the authors reviewed the chart of every patient with SRD who had received SGX to antagonize the neuromuscular blockade utilized intraoperatively. This cohort included over 200 patients and is currently the largest study to report on this topic. Keeping in mind, patients who received kidney transplantation were included in this study, which could contribute some confounding variables for the reported results with the function of the newly transplanted organ.

The authors defined primary outcome of hypersensitivity reactions, need for reintubation, hypoxemia, residual neuromuscular blockade, and pneumonia as these could be attributed to the SGX complex persisting in circulation until dialysis is initiated. Although five instances of the primary outcome occurred (3 re-intubations and 2 hypoxemic patients), the authors did not feel that SGX definitively contributed to the complications. While not definitive, this work led the authors to conclude that SGX could be considered to antagonize the neuromuscular blockade in patients with ESRD.

After reading this article, would you use SGX in patients with ESRD?