The Use of Intraoperative Dexmedetomidine Is Not Associated With a Reduction in Acute Kidney Injury After Lung Cancer Surgery

Moon, Teresa; Tsai, January; Vachhani, Shital; Peng, Szu Po; Feng, Lei; Vaporciyan, Ara A.; Cata, Juan P.

doi:10.1053/j.jvca.2015.03.025

Cited by 20 publications

(28 citation statements)

References 25 publications

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“…The primary outcome of this study was AKI incidence within 72 h after surgery, on postoperative day 7 and the time of hospital discharge. We estimated the incidence of AKI using AKIN criteria as defined in previous studies [14,15].…”

Section: Discussionmentioning

confidence: 99%

Identification of risk factors associated with postoperative acute kidney injury after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy: a retrospective study

Cata

Zavala

Meter

et al. 2017

International Journal of Hyperthermia

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Section: Discussionmentioning

confidence: 99%

Identification of risk factors associated with postoperative acute kidney injury after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy: a retrospective study

Cata

Zavala

Meter

et al. 2017

International Journal of Hyperthermia

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“…A total of 19 studies with 3,395 patients were included in the final pooled analyses. [3][4][5][6][7][8][11][12][13][14][15][16][17][18][19][20][21][22][23] Of these patients, 1,683 received dexmedetomidine while 1,652 did not. Study review and inclusion is outlined in Figure 1.…”

Section: Manuscript Identification and Characteristicsmentioning

confidence: 99%

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

Loomba

Villarreal

Dhargalkar

et al. 2021

Clinical Pharmacy Therapeu

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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.

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“…In a placebo-controlled double-blind RCT dexmedetomidine demonstrated significant diuretic effects, with an almost 75% increase in diuresis after cardiac surgery, but did not affect renal function per se [180]. Observational trials indicated protection of kidney function after cardiac surgery [181] but not when used for sedation during lung cancer resection [182]. A placebo-controlled study in 90 patients undergoing coronary artery bypass graft (CABG) showed a dose-dependent reduction of NGAL levels with dexmedetomidine used for postoperative sedation [183].…”

Section: Sedationmentioning

confidence: 99%

Prevention of acute kidney injury and protection of renal function in the intensive care unit: update 2017

et al. 2017

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BackgroundAcute kidney injury (AKI) in the intensive care unit is associated with significant mortality and morbidity.ObjectivesTo determine and update previous recommendations for the prevention of AKI, specifically the role of fluids, diuretics, inotropes, vasopressors/vasodilators, hormonal and nutritional interventions, sedatives, statins, remote ischaemic preconditioning and care bundles.MethodA systematic search of the literature was performed for studies published between 1966 and March 2017 using these potential protective strategies in adult patients at risk of AKI. The following clinical conditions were considered: major surgery, critical illness, sepsis, shock, exposure to potentially nephrotoxic drugs and radiocontrast. Clinical endpoints included incidence or grade of AKI, the need for renal replacement therapy and mortality. Studies were graded according to the international GRADE system.ResultsWe formulated 12 recommendations, 13 suggestions and seven best practice statements. The few strong recommendations with high-level evidence are mostly against the intervention in question (starches, low-dose dopamine, statins in cardiac surgery). Strong recommendations with lower-level evidence include controlled fluid resuscitation with crystalloids, avoiding fluid overload, titration of norepinephrine to a target MAP of 65–70 mmHg (unless chronic hypertension) and not using diuretics or levosimendan for kidney protection solely.ConclusionThe results of recent randomised controlled trials have allowed the formulation of new recommendations and/or increase the strength of previous recommendations. On the other hand, in many domains the available evidence remains insufficient, resulting from the limited quality of the clinical trials and the poor reporting of kidney outcomes.Electronic supplementary materialThe online version of this article (doi:10.1007/s00134-017-4832-y) contains supplementary material, which is available to authorized users.

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The Use of Intraoperative Dexmedetomidine Is Not Associated With a Reduction in Acute Kidney Injury After Lung Cancer Surgery

Cited by 20 publications

References 25 publications

Identification of risk factors associated with postoperative acute kidney injury after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy: a retrospective study

Identification of risk factors associated with postoperative acute kidney injury after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy: a retrospective study

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

Prevention of acute kidney injury and protection of renal function in the intensive care unit: update 2017

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