The effect of dexmedetomidine on renal function after surgery: A systematic review and meta‐analysis

Abstract

What is known and objective: Acute kidney injury (AKI) is a complication following surgery and has been associated with worsened patient outcomes. Providers have used agents that may confer a degree of renal protection in the perioperative stage.Such is the case of dexmedetomidine, a selective alpha-2 adrenergic agonist used in the intensive care unit (ICU) as a sedative agent. The primary objective of this metaanalysis was to characterize the use of dexmedetomidine and to evaluate its impact on renal markers and outcomes in patients after surgery.Methods: A systematic review of manuscripts was performed to identify patients who received dexmedetomidine after surgery by searching the PubMed, Embase, and Cochrane databases. The following parameters were captured: blood urea nitrogen (BUN), serum creatinine, creatinine clearance, neutrophil gelatinase-associated lipoprotein (NGAL), cystatin C, urine output, duration of mechanical ventilation, ICU length of stay, AKI, need for dialysis, and mortality. Results and Discussion:Nineteen studies with 3,395 patients were included in the analyses. The mean bolus and infusion dose of dexmedetomidine were 0.82 µg/kg and 0.54 mcg/kg/hr, respectively. There was a significant difference in creatinine clearance and NGAL in favour of the dexmedetomidine group. In addition, the dexmedetomidine group had a shorter ICU length of stay, and a lower risk of acute kidney injury and mortality compared to the control. There was no difference in the rest of the parameters. What is new and conclusion: Dexmedetomidine appears to have postoperative renalprotective effects. This is evidenced by lower NGAL levels and increased creatinine clearance in those who received dexmedetomidine. These effects are associated with decreases in ICU length of stay and risk of AKI and mortality. K E Y W O R D S acute kidney injury, blood urea nitrogen, creatinine, dexmedetomidine, length of stay, postoperative complications A systematic review of the literature was performed to identify published retrospective or prospective case series and randomized clinical studies describing the use of dexmedetomidine and its impact on renal function. This was a newly conducted review without a previously established protocol. The reporting of this systematic review was guided by the standards of the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) Statement.

Dex modulates the balance of water-electrolyte metabolism by depressing the expression of AVP in PVN

“…Dex did not significantly alter serum phosphorus, calcium, and uric acid, those electrolyte and renal function indexes we have tested all indicate that there was no substantive lesion in the renal parenchyma except serum sodium fluctuated within clinical normal ranges, for example, the normal ranges of BUN in male mice are 2.8–13.3 mmol/L ( Boehm et al, 2007 ). In addition, the decrease in serum CRE concentration indicates an increase in the creatinine clearance rate to a certain extent, which is consistent with previous research results ( Loomba et al, 2022 ). However, the above changes in renal function indicators suggest that Dex did not cause substantial damage to renal function.…”

The Effect of Aminophylline on Urine Output and Fluid Balance after a Single Dose in Children Admitted to the Pediatric Cardiac Intensive Care Unit

“…[18][19][20][21] Other medications utilized in the pediatric cardiac intensive care unit have also been noted to be incidentally associated with an increase in urine output and a lower risk of acute kidney injury, specifically, dexmedetomidine. 22 Aminophylline's effects on the kidneys are likely mediated by several mechanisms that are shared by all xanthine derivatives in a dose-dependent manner. Lower concentrations (2-3 µg/mL of theophylline equivalents) have been shown to result in adenosine receptor antagonism leading to inhibition of adenosine-related vasoconstriction of the afferent arterioles and improvement in renal blood flow.…”

“…18 19 20 21 Other medications utilized in the pediatric cardiac intensive care unit have also been noted to be incidentally associated with an increase in urine output and a lower risk of acute kidney injury, specifically, dexmedetomidine. 22…”

Perioperative Dexmedetomidine and Renal Protection: Promising and More Investigation is Warranted

“…A meta-analysis by Loomba et al found reductions in AKI, length of stay, and mortality in patients exposed to dexmedetomidine. 16 The authors found an average bolus dose of 0.82 mg/ kg and an average infusion dose of 0.54 mg/kg/h. 16 In the 2 largest randomized, double-blind, placebo-controlled trials involving solely cardiac surgical patients, an infusion of dexmedetomidine at 0.4 mg/kg/h with no bolus was initiated after the induction of anesthesia and continued for 24 hours (in the study by Soh et al with 108 total patients) or continued for 24 hours after the end of surgery (in the study by Cho et al with 200 total patients).…”

“…16 The authors found an average bolus dose of 0.82 mg/ kg and an average infusion dose of 0.54 mg/kg/h. 16 In the 2 largest randomized, double-blind, placebo-controlled trials involving solely cardiac surgical patients, an infusion of dexmedetomidine at 0.4 mg/kg/h with no bolus was initiated after the induction of anesthesia and continued for 24 hours (in the study by Soh et al with 108 total patients) or continued for 24 hours after the end of surgery (in the study by Cho et al with 200 total patients). 9,10 The authors of these studies noted no differences in bradycardia or hypotension between placebo and dexmedetomidine, suggesting that perhaps a dexmedetomidine dose of 0.4 mg/kg/h is a reasonable choice for the intervention arm of a larger trial.…”