Intraoperative dexmedetomidine reduced the risk of acute kidney injury by 46% (RR 0.54) compared to placebo in high-risk patients undergoing non-cardiac surgery, but showed no significant benefit in low-risk patients.
RCT (n=611)
Double-blind
1:1
No
Does intraoperative dexmedetomidine reduce the incidence of acute kidney injury in high-risk and low-risk patients aged ≥ 60 years undergoing non-cardiac surgery?
Intraoperative dexmedetomidine significantly reduces the risk of postoperative acute kidney injury in elderly patients at high risk for AKI undergoing non-cardiac surgery, but provides no significant benefit for low-risk patients.
Relative Risk: 0.54 (95% CI 0.29–1)
Absolute Event Rate: 12.6% vs 23.4%
p-value: p=0.043
Abstract Purpose Acute kidney injury (AKI) is a significant postoperative complication associated with poor long-term outcomes. Dexmedetomidine, a selective α₂-adrenergic agonist with anti-inflammatory properties, may protect the kidney during non-cardiac surgery. This study examined whether intraoperative dexmedetomidine reduces AKI in both high-risk and low-risk patients. Methods This was a secondary analysis of a randomized double-blind placebo-controlled trial. Patients aged ≥ 60 years scheduled for elective non-cardiac surgery expected to last ≥ 2 h under general anesthesia were enrolled and classified as low-risk or high-risk using the General Surgery Acute Kidney Injury Risk Index. Participants were randomly allocated to receive intraoperative dexmedetomidine (loading dose 0.6 μg/kg over 10 min before induction, followed by 0.5 μg/kg/h until 1 h before surgery end) or normal saline. The primary endpoint was AKI incidence within 7 postoperative days. Results Among high-risk patients, AKI occurred in 12.6% (13/103) of the dexmedetomidine group versus 23.4% (25/107) of controls (RR 0.54, 95% CI 0.29 to 1.00, P = 0.043); after multivariable adjustment, dexmedetomidine remained independently associated with lower AKI risk (OR 0.44, 95% CI 0.20 to 0.98, P = 0.045). In contrast, low-risk patients showed no significant difference with or without dexmedetomidine (7.9% vs 9.6%; RR 0.82, 95% CI 0.44 to 1.55, P = 0.543; adjusted OR 0.65, 95% CI 0.30 to 1.38, P = 0.260). Urological surgery was an independent predictor of AKI across the entire cohort. Conclusion Intraoperative dexmedetomidine was associated with lower risk of AKI in high-risk but not in low-risk patients undergoing non-cardiac surgery.
Liang et al. (Sat,) conducted a rct in Acute kidney injury (n=611). Dexmedetomidine vs. Normal saline was evaluated on Incidence of AKI within 7 postoperative days in high-risk patients (RR 0.54, 95% CI 0.29 to 1.00, p=0.043). Intraoperative dexmedetomidine reduced the risk of acute kidney injury by 46% (RR 0.54) compared to placebo in high-risk patients undergoing non-cardiac surgery, but showed no significant benefit in low-risk patients.