Reversal of rocuronium-induced neuromuscular blockade by sugammadex in patients undergoing kidney transplantation: Pharmacokinetics, efficacy, and safety analyses

Background

The pharmacokinetics of sugammadex were significantly different between severe renal failure patients and healthy subjects. The objective of our study is to investigate the pharmacokinetics of sugammadex in patients with end-stage renal disease undergoing kidney transplantation.

Methods

Seventeen ASA class III renal failure patients undergoing kidney transplantation and 17 ASA I-II healthy controls were included. Sugammadex 2 mg·kg⁻¹ was administered at reappearance of the second twitch of the train-of-four for reversal of rocuronium-induced neuromuscular blockade. Plasma concentration of sugammadex was measured at regular time points and pharmacokinetics determined using non-compartmental analysis.

Results

Pharmacokinetic data of sugammadex were obtained from 30 patients. The geometric mean of elimination half-life of sugammadex was 10 h in renal failure and 2 h in controls (P < 0.001). The geometric mean of plasma clearance of sugammadex was significantly different between the two groups (15.2 ml·min⁻¹ in renal patients vs 82.5 ml·min⁻¹ in controls, P<0.001). The recovery of train-of-four-ratio ≥ 0.9 was similar between the two groups. No sugammadex-related serious adverse events were considered.

Conclusion

The significant differences in the pharmacokinetics of sugammadex between the patients undergoing kidney transplantation and healthy controls were observed. In patients with end-stage renal disease, sugammadex 2 mg·kg⁻¹ provided a safety profile similar to healthy controls. Sugammadex is safe and effective for patients undergoing kidney transplantation, although the clearance of sugammadex is slower in this patient population.