Remimazolam stabilizes hemodynamics during anesthesia induction but fails to reduce renal injury risk following laparoscopic partial nephrectomy: a propensity score-matched retrospective cohort study

doi:10.12122/j.issn.1673-4254.2026.09.07

Abstract

Abstract:

Objective To investigate the effects of remimazolam administered during anesthesia induction on hemodynamics and postoperative renal function in patients undergoing laparoscopic partial nephrectomy (LPN). Methods Clinical data of 265 renal tumor patients undergoing LPN between January, 2022 and December, 2024 were collected. The patients were divided into control group and remimazolam group (0.2 mg/kg for induction), and after propensity score matching (PSM), 65 patients in each group were included. Mean arterial pressure (MAP) and heart rate (HR) were recorded before induction (T₀), immediately after induction (T₁), immediately after intubation (T₂), and 10 min after intubation (T₃). Renal function indicators at 24 h postoperatively and incidences of acute kidney injury (AKI) were recorded. Estimated glomerular filtration rates (eGFRsCr, eGFRCys-C, and eGFRdiff) were calculated using serum creatinine (sCr) and cystatin C (Cys-C). From 36 patients in control group and 41 patients in remimazolam group followed up for 3-12 months, eGFRsCr data were collected to evaluate the incidence of chronic kidney disease (CKD) and analyze its correlation with AKI. Results After PSM and covariate adjustment, remimazolam group showed significantly smaller changes than control group in ΔMAP at T3 (-20.11±11.65 vs -13.54±12.75 mmHg, P<0.05), ΔHR at T2 (-3.78±11.18 vs 2.82±10.79 min^-1, P<0.05), and ΔHR at T3 (-10.85±15.54 vs -3.35±11.67 min^-1, P<0.05). The remimazolam group showed significantly higher postoperative Cys-C level than the control group [0.96 (0.96, 1.03) vs 0.91 (0.77, 1.01), P<0.05] but lower eGFRCys-C at 24 h (83.65±9.84 vs 94.83±20.92, P<0.05). eGFRdiff showed a significant negative shift in remimazolam group (18.55±17.06 vs 8.52±15.85, P<0.05). Other indicators did not differ significantly between the two groups. AKI showed a significant correlation with CKD following LPN (P<0.05). Conclusion Compared with propofol, remimazolam induction improves hemodynamic stability during anesthesia induction but does not reduce the incidences of postoperative AKI or CKD after LPN.

Key words: remimazolam, partial nephrectomy, hemodynamics, Cystatin C, acute kidney injury, chronic kidney disease, propensity score matching

Changhong SUN, Fei LIU, Jiaxin LI, Han GAO, Yi LIU, Longhe XU, Yongzhe LIU, Minglong GAO. Remimazolam stabilizes hemodynamics during anesthesia induction but fails to reduce renal injury risk following laparoscopic partial nephrectomy: a propensity score-matched retrospective cohort study[J]. Journal of Southern Medical University, 2026, 46(9): 2069-2077.

Figures/Tables 9

References 39

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Variable	Before PSM				After PSM
Variable	Control group (n=184)	Remimazolam group (n=81)	t/x²/z	P	Control group (n=65)	Remimazolam group (n=65)	t/x²/z	P
Age (year, Mean±SD)	52±14	54±12	-1.148	0.252	53±15	54±11	-0.448	0.655
Male/Female (n)	122/62	53/28	0.019	0.890	46/19	46/19	0.000	1.000
BMI (kg/m², Mean±SD)	25.42±12.37	25.58±11.47	-0.348	0.728	25.61±4.15	25.83±3.22	-0.335	0.738
ASA [n (%)]			1.208	0.751			1.592	0.661
Ⅰ	40 (21.7)	14 (17.3)			11 (16.9)	12 (18.5)
Ⅱ	133 (72.3)	63 (77.8)			48 (73.8)	49 (75.4)
Ⅲ	11 (6.0)	4 (4.9)			6 (9.2)	4 (6.2)
Combined disease [n (%)]
Diabetes	25 (13.6)	12 (14.8)	0.071	0.79	9 (13.8)	11 (16.9)	0.236	0.627
Hypertension	70 (38.0)	25 (30.9)	1.260	0.262	25 (38.5)	24 (36.9)	0.033	0.856
Cardiovascular disease	23 (12.5)	12 (14.8)	0.263	0.608	11 (16.9)	12 (18.5)	0.053	0.818
Operation time [min, M (P₂₅, P₇₅)]	126.50 (105.50, 148.00)	130.00 (110.00, 170.00)	1.975	0.048	135.0 (110.0, 157.5)	130.0 (110.0, 162.50)	-0.021	0.983
Renal artery occlusion time [min, M (P₂₅, P₇₅)]	23.00 (16.25, 28.00)	21.00 (17.00, 27.00)	-0.602	0.547	22.0 (15.0, 28.0)	23.0 (17.50, 27.0)	0.545	0.585
Preoperative sCr [μmol/L, M (P₂₅, P₇₅)]	67.0 (56.0, 77.0)	68.0 (55.0, 77.5)	-0.064	0.949	69.00 (60.50, 76.50)	69.00 (55.50, 76.50)	-0.431	0.667
Preoperative β₂-MG [mg/L, M (P₂₅, P₇₅)]	1.61 (1.38, 1.92)	2.03 (1.85, 2.29)	6.896	<0.01	2.03 (1.69, 2.37)	2.01 (1.86, 2.23)	0.123	0.902
Preoperative Cys-C [mg/L, M (P₂₅, P₇₅)]	0.77 (0.68, 0.88)	0.84 (0.84, 0.90)	4.926	<0.01	0.84 (0.80, 0.97)	0.84 (0.84, 0.90)	-0.060	0.956
Preoperative CRP [mg/L, M (P₂₅, P₇₅)]	1.49 (0.66, 4.56)	1.50 (0.72, 5.80)	0.474	0.635	1.48 (0.52, 5.93)	1.62 (0.69, 5.30)	-0.228	0.820
Preoperative eGFRsCr [mL/(min·1.73 m²), Mean±SD]	91.47±16.60	91.00±16.44	0.216	0.829	89.69±18.48	91.59±16.76	-0.614	0.540
Preoperative eGFRCys-C [mL/(min·1.73 m²), M (P₂₅, P₇₅)]	109.25 (96.58, 119.25)	103.16 (90.79, 109.56)	-3.957	<0.01	101.93 (82.65, 112.99)	103.99 (91.63, 108.24)	0.102	0.918
Preoperative eGFRdiff [mL/(min·1.73 m²), Mean±SD]	14.51±16.98	7.59±16.62	3.075	0.002	6.94±15.46	7.81±13.71	-0.339	0.735

Variable	Before PSM				After PSM
Variable	Control group (n=184)	Remimazolam group (n=81)	t/x²/z	P	Control group (n=65)	Remimazolam group (n=65)	t/x²/z	P
Age (year, Mean±SD)	52±14	54±12	-1.148	0.252	53±15	54±11	-0.448	0.655
Male/Female (n)	122/62	53/28	0.019	0.890	46/19	46/19	0.000	1.000
BMI (kg/m², Mean±SD)	25.42±12.37	25.58±11.47	-0.348	0.728	25.61±4.15	25.83±3.22	-0.335	0.738
ASA [n (%)]			1.208	0.751			1.592	0.661
Ⅰ	40 (21.7)	14 (17.3)			11 (16.9)	12 (18.5)
Ⅱ	133 (72.3)	63 (77.8)			48 (73.8)	49 (75.4)
Ⅲ	11 (6.0)	4 (4.9)			6 (9.2)	4 (6.2)
Combined disease [n (%)]
Diabetes	25 (13.6)	12 (14.8)	0.071	0.79	9 (13.8)	11 (16.9)	0.236	0.627
Hypertension	70 (38.0)	25 (30.9)	1.260	0.262	25 (38.5)	24 (36.9)	0.033	0.856
Cardiovascular disease	23 (12.5)	12 (14.8)	0.263	0.608	11 (16.9)	12 (18.5)	0.053	0.818
Operation time [min, M (P₂₅, P₇₅)]	126.50 (105.50, 148.00)	130.00 (110.00, 170.00)	1.975	0.048	135.0 (110.0, 157.5)	130.0 (110.0, 162.50)	-0.021	0.983
Renal artery occlusion time [min, M (P₂₅, P₇₅)]	23.00 (16.25, 28.00)	21.00 (17.00, 27.00)	-0.602	0.547	22.0 (15.0, 28.0)	23.0 (17.50, 27.0)	0.545	0.585
Preoperative sCr [μmol/L, M (P₂₅, P₇₅)]	67.0 (56.0, 77.0)	68.0 (55.0, 77.5)	-0.064	0.949	69.00 (60.50, 76.50)	69.00 (55.50, 76.50)	-0.431	0.667
Preoperative β₂-MG [mg/L, M (P₂₅, P₇₅)]	1.61 (1.38, 1.92)	2.03 (1.85, 2.29)	6.896	<0.01	2.03 (1.69, 2.37)	2.01 (1.86, 2.23)	0.123	0.902
Preoperative Cys-C [mg/L, M (P₂₅, P₇₅)]	0.77 (0.68, 0.88)	0.84 (0.84, 0.90)	4.926	<0.01	0.84 (0.80, 0.97)	0.84 (0.84, 0.90)	-0.060	0.956
Preoperative CRP [mg/L, M (P₂₅, P₇₅)]	1.49 (0.66, 4.56)	1.50 (0.72, 5.80)	0.474	0.635	1.48 (0.52, 5.93)	1.62 (0.69, 5.30)	-0.228	0.820
Preoperative eGFRsCr [mL/(min·1.73 m²), Mean±SD]	91.47±16.60	91.00±16.44	0.216	0.829	89.69±18.48	91.59±16.76	-0.614	0.540
Preoperative eGFRCys-C [mL/(min·1.73 m²), M (P₂₅, P₇₅)]	109.25 (96.58, 119.25)	103.16 (90.79, 109.56)	-3.957	<0.01	101.93 (82.65, 112.99)	103.99 (91.63, 108.24)	0.102	0.918
Preoperative eGFRdiff [mL/(min·1.73 m²), Mean±SD]	14.51±16.98	7.59±16.62	3.075	0.002	6.94±15.46	7.81±13.71	-0.339	0.735

Variable	SMD before PSM	SMD after PSM	Balance status (After PSM)
Age	0.144	0.079	Good (<0.1)
Male/Female	0.018	0	Good (<0.1)
BMI	0.046	0.059	Good (<0.1)
ASA	0.07	0.093	Good (<0.1)
Combined disease
Diabetes	0.035	0.085	Good (<0.1)
Hypertension	0.15	0.032	Good (<0.1)
Cardiovascular disease	0.068	0.04	Good (<0.1)
Operation time	0.363	0.03	Good (<0.1)
Renal artery occlusion time	0.084	0.014	Good (<0.1)
Preoperative sCr	0.062	0.187	Acceptable (0.1~0.2)
Preoperative β₂-MG	0.817	0.082	Good (<0.1)
Preoperative Cys-C	0.458	0.202	Acceptable (0.1~0.2)
Preoperative CRP	0.098	0.114	Acceptable (0.1~0.2)

Variable	SMD before PSM	SMD after PSM	Balance status (After PSM)
Age	0.144	0.079	Good (<0.1)
Male/Female	0.018	0	Good (<0.1)
BMI	0.046	0.059	Good (<0.1)
ASA	0.07	0.093	Good (<0.1)
Combined disease
Diabetes	0.035	0.085	Good (<0.1)
Hypertension	0.15	0.032	Good (<0.1)
Cardiovascular disease	0.068	0.04	Good (<0.1)
Operation time	0.363	0.03	Good (<0.1)
Renal artery occlusion time	0.084	0.014	Good (<0.1)
Preoperative sCr	0.062	0.187	Acceptable (0.1~0.2)
Preoperative β₂-MG	0.817	0.082	Good (<0.1)
Preoperative Cys-C	0.458	0.202	Acceptable (0.1~0.2)
Preoperative CRP	0.098	0.114	Acceptable (0.1~0.2)

Group	∆MAP (mmHg)			∆HR (beat/min)
Group	∆MAP₁	∆MAP₂	∆MAP₃	∆HR₁	∆HR₂	∆HR₃
Control	-4.62±8.75	-9.38±12.97	-20.11±11.65	-2.09±9.50	-3.78±11.18	-10.85±15.54
Remimazolam	-2.71±6.72	-7.15±12.07	-13.54±12.75	0.63±6.00	2.82±10.79	-3.35±11.67
t	-1.395	-1.015	-3.067	-1.954	-3.426	-3.108
P	0.165	0.312	0.003	0.053	0.001	0.002
Corrected P-value	0.990	1.000	0.018	0.318	0.006	0.012