Reno-protective effects of perioperative dexmedetomidine in kidney transplantation: a systematic review and meta-analysis of randomized controlled trials

Abstract

Background and objective There is currently no FDA-approved medical therapy for delayed graft function (DGF). Dexmedetomidine (DEX) has multiple reno-protective effects preventing ischemic reperfusion injury, DGF, and acute kidney injury. Therefore, we aimed to evaluate the reno-protective effects of perioperative DEX during renal transplantation. Methods A systematic review and meta-analysis synthesizing randomized controlled trials (RCTs) from WOS, SCOPUS, EMBASE, PubMed, and CENTRAL until June 8th, 2022. We used the risk ratio (RR) for dichotomous outcomes and the mean difference for continuous outcomes; both presented with the corresponding 95% confidence interval (CI). We registered our protocol in PROSPERO with ID: CRD42022338898. Results We included four RCTs with 339 patients. Pooled risk ratio found no difference between DEX and placebo in reducing DGF (RR: 0.58 with 95% CI [0.34, 1.01], p = 0.05) and acute rejection (RR: 0.88 with 95% CI [0.52, 1.49], p = 0.63). However, DEX improved short-term creatinine on day 1 (MD: − 0.76 with 95% CI [− 1.23, − 0.3], p = 0.001) and day 2 (MD: − 0.28 with 95% CI [− 0.5, − 0.07], p = 0.01); and blood urea nitrogen on day 2 (MD: − 10.16 with 95% CI [− 17.21, − 3.10], p = 0.005) and day 3 (MD: − 6.72 with 95% CI [− 12.85, − 0.58], p = 0.03). Conclusion Although there is no difference between DEX and placebo regarding reducing DGF and acute rejection after kidney transplantation, there may be some evidence that it has reno-protective benefits because we found statistically significant improvement in the short-term serum creatinine and blood urea nitrogen levels. More trials are required to investigate the long-term reno-protective effects of DEX.

Multiple-Factors-Induced Rheumatoid Arthritis Synoviocyte Activation Is Attenuated by the α2-Adrenergic Receptor Agonist Dexmedetomidine

“…Difficulties in the treatment of RA are caused by mu that attenuate inflammatory cytokines. Dex is known to induce sedation against inflammatory processes in various tissues, such as the brain, heart [35][36][37][38]. In this study, Dex attenuated the inflammatory effects of cellular resp…”

“…Difficulties in the treatment of RA are caused by multiple targets that attenuate inflammatory cytokines. Dex is known to induce sedation and protect against inflammatory processes in various tissues, such as the brain, heart, and kidney [ 35 , 36 , 37 , 38 ]. In this study, Dex attenuated the inflammatory effects of cellular responses mediated by multiple inflammatory inputs, including cellular migration and cytokine production in RA-FLSs ( Figure 7 ).…”

Haemodynamic Effect of Dexmedetomidine During Pediatric Kidney Transplantation: A Single-Center Retrospective Study

“…Other authors have noted a reduction in post-operative creatinine levels on day 2 of kidney transplantation, but not on day 7 [31], a lower incidence of DGF [11], and less AKI after non-cardiac surgery [32], cardiac surgery [8] or pediatric cardiac surgery [33]. In a more nuanced way, a recent meta-analysis found no dexmedetomidinerelated difference in DGF and acute graft rejection, but a trend towards a more rapid reduction in serum creatinine and urea [34].…”

Dexmedetomidine and acute kidney injury after non-cardiac surgery: A meta-analysis with trial sequential analysis

“…Another study by Hu, et al included four RCTs and two retrospective studies to show that dexmedetomidine did not reduce the rate of AKI after non-cardiac surgery [8]; however, the results were limited by a small number of trials, low quality of evidence, and lack of renal function parameters. Abuelazm and colleagues performed a meta-analysis evaluating the impact of dexmedetomidine on renal outcomes in kidney transplantation only, without other types of surgery [42]. A recent retrospective cohort study of 2391 patients undergoing non-cardiac surgery suggested that intraoperative dexmedetomidine was associated with a reduced incidence and severity of AKI [43].…”