A retrospective matched cohort analysis examined whether RCFF influences postoperative kidney stability in adults with T2DM exposed to sevoflurane or desflurane. The study, reported in Renal Failure, evaluated postoperative renal function and the contribution of RCFF to renal vulnerability.

Adults undergoing non-cardiac surgery lasting more than three hours were included if they had preoperative abdominal magnetic resonance imaging (MRI) with proton density fat fraction sequences. Propensity score matching (PSM) created balanced exposure groups. Multivariate logistic regression identified predictors of postoperative renal decline, defined as a sustained 25% or greater decrease in eGFR through postoperative day seven.

A total of 158 matched adults were analyzed. Sustained eGFR decline occurred in 57.6% of participants. Rates were similar between anesthetic groups, with 63.3% in the sevoflurane group and 51.9% in the desflurane group (p = 0.198). Lower baseline eGFR and lower RCFF predicted eGFR decline only under sevoflurane. An RCFF threshold of 2% identified higher susceptibility. Individuals with RCFF below 2% had an 81.8% decline rate under sevoflurane compared with 53.3% above this threshold.

These findings suggest that low RCFF increases renal sensitivity to sevoflurane in T2DM and supports selective anesthetic planning when renal reserves appear limited.