Dexmedetomidine prevents acute kidney injury after adult cardiac surgery: a meta-analysis of randomized controlled trials

Abstract

BackgroundDexmedetomidine has been shown to confer direct renoprotection by stabilizing the sympathetic system, exerting anti-inflammatory effects and attenuating ischemia/reperfusion (I/R) injury in preclinical studies. Results from clinical trials of dexmedetomidine on acute kidney injury (AKI) following adult cardiac surgery are controversial.MethodsWe searched EMBASE, PubMed, and Cochrane CENTRAL databases for randomized controlled trials (RCTs) comparing the renal effect of dexmedetomidine versus placebo or other anesthetic drugs in adult patients undergoing cardiac surgery. The primary outcome was the incidence of AKI. The secondary outcomes were mechanical ventilation (MV) duration, intensive care unit (ICU) stay and hospital length of stay(LOS), and postoperative mortality (in-hospital or within 30 days).ResultsTen trials with a total of 1575 study patients were selected. Compared with controls, dexmedetomidine significantly reduced the incidence of postoperative AKI [68/788 vs 97/787; odds ratio(OR), 0.65; 95% confidence interval (CI), 0.45–0.92; P = 0.02; I2 = 0.0%], and there was no difference between groups in postoperative mortality (4/487 vs 11/483; OR, 0.43; 95% CI, 0.14–1.28; P = 0.13; I2 = 0.0%), MV duration [in days; n = 1229; weighted mean difference(WMD), −0.22; 95% CI, −2.04 to 1.70; P = 0.81], ICU stay (in days; n = 1363; WMD, −0.85; 95% CI, −2.14 to 0.45; P = 0.20), and hospital LOS (in days; n = 878; WMD, −0.24; 95% CI, −0.71 to 0.23; P = 0.32).ConclusionsPerioperative administration of dexmedetomidine in adult patients undergoing cardiac surgery may reduce the incidence of postoperative AKI. Future trials are needed to determine the dose and timing of dexmedetomidine in improving outcomes, especially in patients with decreased baseline kidney function.

Acute Kidney Injury Associated with Cardiac Surgery: a Comprehensive Literature Review

“…Older age, intra and postoperative blood transfusions, nonemergent surgery, gender, and increased preoperative SCr and uric acid levels have all been attributed as risk factors for failure to respond to RRT [53] . RRT also exposes patients to a variety of risks, including the possibility of developing encephalopathy, aspiration, coagulopathies, such as bleeding disorders and plate dysfunction, and bacteraemia.…”

Efficacy of dexmedetomidine in prevention of junctional ectopic tachycardia and acute kidney injury after pediatric cardiac surgery: A meta‐analysis

“…Currently, several small, single‐center randomized controlled trials (RCTs) reported that prophylactic dexmedetomidine is useful for the prevention of JET in pediatric cardiac surgery patients . Furthermore, the present research also suggested that the administration of dexmedetomidine might reduce the incidence of AKI after cardiac surgery with CPB . However, there are few reviews that have evaluated the effects of prophylactic perioperative dexmedetomidine administration on JET and AKI in pediatric patients having undergone cardiac surgery.…”

“…To date, the exact mechanism by which dexmedetomidine plays a renoprotective role is not well understood, but anti‐inflammation, sympatholytic effects, cytoprotective effects and diuresis may be the major contributors in reducing deterioration of renal function . The latest meta‐analysis with 1575 patients suggested that perioperative administration of dexmedetomidine in adults undergoing cardiac surgery may reduce the risk of postoperative AKI (OR: 0.65, 95% CI: 0.45 to 0.92, P = .02) . However, the effects of dexmedetomidine on postoperative renal function in pediatric cardiac surgery patients remained unclear.…”

“…[13][14][15][16] Furthermore, the present research also suggested that the administration of dexmedetomidine might reduce the incidence of AKI after cardiac surgery with CPB. 17 However, there are few reviews that have evaluated the effects of prophylactic perioperative dexmedetomidine administration on JET and AKI in pediatric patients having undergone cardiac surgery.…”

Prävention der akuten Nierenschädigung beim kritisch kranken Patienten

“…Des Weiteren wies eine kleine randomisierte kontrollierte Studie eine geringere AKI-Rate sowie geringere Cystatin-C-Werte bei Patienten, die mit Propofol im Gegensatz zu Sevofluran behandelt wurden, nach [35]. Auch für die perioperative Anwendung von Dexmedetomidin zeigt sich ein eventueller Vorteil in der Reduktion der AKI-Rate [14,45].…”