Postoperative renal failure remains a major determinant of morbidity and mortality after cardiac surgery, with limited preventive pharmacological options. Enoximone, a phosphodiesterase III inhibitor with inotropic and anti-inflammatory properties, has shown potential for organ protection during cardiopulmonary bypass. We aimed to evaluate the effect of perioperative enoximone administration on renal function and clinical outcomes in patients undergoing on-pump cardiac surgery.

This multicentre prospective observational study included adult patients undergoing on-pump cardiac surgery. Patients with severe preoperative kidney failure were excluded. Renal function was assessed at postoperative days 2, 7, and 30 using estimated glomerular filtration rate (eGFR) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) stage. Perioperative administration of enoximone was compared with untreated controls using propensity score matching.

A total of 237 patients were included, of whom 110 (46.4%) received enoximone. After matching, 72 treated patients were compared with 72 controls. No differences in eGFR were observed at day 2 and day 7. At day 30, enoximone was associated with greater eGFR improvement (+8.1 vs –3.7 mL/min/1.73 m²; p<0.001). CKD-EPI stage improved in the Enoximone-treated group at day 7 (–0.3±0.6; p=0.037) and day 30 (–0.3±0.5; p<0.001). Enoximone was an independent predictor of 30-day eGFR improvement (β=+10.65; p<0.001) and CKD-EPI reduction (β=–0.26; p=0.002). Enoximone was also associated with reduced use of additional inotropes (4.2% vs 26.4%; p<0.001) and shorter hospital stay (13.2±7.2 vs 17.1±10.5 days; p=0.008).

Perioperative enoximone administration was associated with improved renal function and reduced hospital length of stay in patients undergoing on-pump cardiac surgery. These findings support its potential role in preventing postoperative renal failure. Further studies are warranted to confirm these results.