Effect of dexmedetomidine for prevention of acute kidney injury after cardiac surgery: an updated systematic review and meta-analysis

Liu, Xing; Hu, Qinxue; Chen, Qianxiu; Jia, Jing; Feng, Jianguo

doi:10.1080/0886022x.2022.2097923

Cited by 9 publications

(13 citation statements)

References 31 publications

(28 reference statements)

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“…A recent updated systematic review and meta-analysis of 16 studies involving 2148 patients revealed that dexmedetomidine administration may prevent AKI and postoperative delirium after cardiac surgery. This meta-analysis also suggests that dexmedetomidine may reduce the length of stay in the intensive care unit [175]. Likewise, dexmedetomidine administration was associated with improvements in renal function recovery and in-hospital survival in critically ill patients with septic AKI [79].…”

Section: Sympatholyticsmentioning

confidence: 65%

Reducing Oxygen Demand to Alleviate Acute Kidney Injury

Zhou¹

2023

Front. Biosci. (Landmark Ed)

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Maintaining a balance between the supply and demand of oxygen is vital for proper organ function. Most types of acute kidney injury (AKI) are characterized by hypoxia, a state where the supply of oxygen cannot match the demand for normal cellular activities. Hypoxia results from hypo perfusion and impaired microcirculation in the kidney. It inhibits mitochondrial oxidative phosphorylation, resulting in a decrease in production of adenosine triphosphate (ATP), which is essential to power tubular transport activities, especially reabsorption of Na + , and other vital cellular activities. To ameliorate AKI, the majority of studies have focused on increasing renal oxygen delivery by restoring renal blood flow and altering intra-renal hemodynamics. However, to date these approaches remain inadequate. In addition to augmenting oxygen supply, increasing renal blood flow also increases glomerular filtration rate, leading to increased solute deliver and workload for the renal tubules, causing an increase in oxygen consumption. The relationship between Na + reabsorption and oxygen expenditure in the kidney is linear. Experimental models have demonstrated that inhibition of Na + reabsorption can alleviate AKI. Since the proximal tubules reabsorb approximately 65% of filtered Na + , consuming the largest portion of oxygen, many studies focus on examining the effects of inhibiting Na + reabsorption in this segment. Potential therapeutics that have been examined include acetazolamide, dopamine and its analog, inhibitors of the renin-angiotensin II system, atrial natriuretic peptide, and empagliflozin. The effectiveness of inhibition of Na + reabsorption in the thick ascending limb of the Loop of Henle by furosemide has been also examined. While these approaches produced impressive results in animal models, their clinical benefits remain mixed. This review summarizes the progress in this area and argues that the combination of increasing oxygen supply with decreasing oxygen consumption or different approaches to reducing oxygen demand will be more efficacious.Keywords: mitochondria; oxygenation; hypoxia; Na + -H + exchanger 3; Na + -dependent glucose transporter 2; Na + reabsorption

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Section: Sympatholyticsmentioning

confidence: 65%

Reducing Oxygen Demand to Alleviate Acute Kidney Injury

Zhou¹

2023

Front. Biosci. (Landmark Ed)

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“…Han, Y et al found that intraoperative application of a loading dose of dexamethasone combined with propofol during maintenance of anesthesia reduced heart rate and thus oxygen consumption by cardiac myocytes[28]. In addition, several studies have reported that perioperative use of dexmedetomidine reduced the duration of intensive care and tracheal intubation and the incidence of short-term mortality after cardiac surgery in adults [11,12,29,30]. In our study, we also found that dexmedetomidine as an anesthetic adjuvant was associated with a reduced incidence of major postoperative complications and a reduced cicu stay.…”

Section: Discussionmentioning

confidence: 99%

Dexmedetomidine as an anesthetic adjunct is associated with reduced complications and CICU length of stay after heart valve surgery

Fan

Tang

Pan

et al. 2023

Preprint

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Background: We sought to explore the relationship between dexmedetomidine as an anesthetic adjuvant in cardiac surgery and postoperative complications and length of stay (LOS) in the cardiac intensive care unit (CICU). Methods: We conducted a retrospective study of patients aged 18 years and older who underwent heart valve surgery between October 2020 and June 2022. The study endpoints were a combination of adverse outcomes, which included major postoperative complications (cardiac arrest, atrial fibrillation, myocardial injury/infarction, heart failure) and prolonged CICU LOS (defined as LOS≥90th percentile). Multivariate logistic regression analysis was performed for variables that were significant in the univariate analysis. Results: A total of 856 patients entered our study. Of these, 283（33.06%） patients experienced at least one adverse outcome and the remaining 573 were included in the prognostic control group. Multivariate logistic regression analysis revealed that age > 60years (odds ratio [OR], 1.73; 95% confidence interval [CI], 1.27–2.37; p=0.01), cardiopulmonary bypass( CPB)> 190min (OR, 1.58; 95% CI, 1.01-2.48; p = 0.04) and postoperative mechanical ventilation time > 10 h (OR, 2.03; 95% CI, 1.49-2.77; p < 0.01) were independent risk factors for major complications and prolonged CICU length of stay in patients undergoing heart valve surgery. Intraoperative use of dexmedetomidine as an anesthetic adjuvant was a protective factor for such patients (odds ratio, 0.53; 95% confidence interval, 0.37-0.78; p = 0.01). Conclusions: Age, duration of cardiopulmonary bypass, and duration of mechanical ventilation are associated with major complications and increased CICU stay after heart valve surgery. Intraoperative use of dexmedetomidine may improve such clinical outcomes.

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“…Moreover, dexmedetomidine was shown to be advantageous for the protection of kidney function in cardiac surgery patients. 105,108,112 Current practices may combine epidural and general anesthesia for better intra-and postoperative pain control with simultaneous opioid sparing. Epidural anesthesia, introduced after the induction of narcosis, resulted in not raised, but decreased serum vasopressin levels when low-pressure pneumoperitoneum (7-9 mmHg) was applied during laparoscopic cholecystectomy.…”

Section: Alternative Techniques For Laparoscopymentioning

confidence: 99%

“…Moreover, dexmedetomidine was shown to be advantageous for the protection of kidney function in cardiac surgery patients. 105,108,112…”

Section: Anesthesia and Analgesiamentioning

confidence: 99%

Pneumoperitoneum and Acute Kidney Injury—An Integrative Clinical Concept Review

et al. 2022

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An increased intraabdominal pressure, particularly when occurring during periods of hemodynamic instability or fluid overload, is regarded as a major contributor to acute kidney injury (AKI) in intensive care units. During abdominal laparoscopic procedures, intraoperative insufflation pressures up to 15 mmHg are applied, to enable visualization and surgical manipulation but with the potential to compromise net renal perfusion. Despite the widely acknowledged renal arterial autoregulation, net arterial perfusion pressure is known to be narrow, and the effective renal medullary perfusion is disproportionately impacted by venous and lymphatic congestion. At present, the potential risk factors, mitigators and risk-stratification of AKI during surgical pneumoperitoneum formation received relatively limited attention among nephrologists and represent an opportunity to look beyond mere blood pressure and intake-output balances. Careful charting and reporting duration and extent of surgical pneumoperitoneum represents an opportunity for anesthesia teams to better communicate intraoperative factors affecting renal outcomes for the postoperative clinical teams. In this current article, the authors are integrating preclinical data and clinical experience to provide a better understanding to optimize renal perfusion during surgeries. Future studies should carefully consider intrabdominal insufflation pressure as a key variable when assessing outcomes and blood pressure goals in these settings.

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Effect of dexmedetomidine for prevention of acute kidney injury after cardiac surgery: an updated systematic review and meta-analysis

Cited by 9 publications

References 31 publications

Reducing Oxygen Demand to Alleviate Acute Kidney Injury

Reducing Oxygen Demand to Alleviate Acute Kidney Injury

Dexmedetomidine as an anesthetic adjunct is associated with reduced complications and CICU length of stay after heart valve surgery

Pneumoperitoneum and Acute Kidney Injury—An Integrative Clinical Concept Review

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