Key result
Dexmedetomidine cuts CSA-AKI incidence by ~56% in randomized trials.
Why the study?
Does dexmedetomidine reduce the incidence of cardiac surgery-associated acute kidney injury in patients undergoing cardiac surgery?
Meta-Analysis (n=19,604)
Does dexmedetomidine reduce the incidence of cardiac surgery-associated acute kidney injury in patients undergoing cardiac surgery?
Dexmedetomidine administration is associated with a significantly reduced incidence of acute kidney injury following cardiac surgery, though it did not significantly decrease postoperative mortality or length of stay.
Answers are grounded in this paper and cite their sources.
Supports dexmedetomidine to reduce CSA-AKI after cardiac surgery; confirms benefit across RCTs and cohorts without mortality or LOS impact.
Dexmedetomidine has a possible protective effect on cardiac surgery-associated acute kidney injury (CSA-AKI); however, current evidence is limited and controversial.We therefore conducted a meta-analysis regarding dexmedetomidine for CSA-AKI.PubMed and EMbase were searched.A random-effects model in RevMan 5.3 software was used, and P < 0.05 indicates statistical significance.Three randomized controlled trials (RCTs) with 338 patients and four cohort studies involving 19,266 participants were included.The main characteristics are shown in Table 1.Overall results show that dexmedetomidine was associated with a significantly reduced incidence of CSA-AKI in both the RCTs (relative risk [RR] 0.44, 95% confidence interval [CI] 0.26-0.76,p = 0.003) and cohort studies (RR 0.74, 95% CI 0.63-0.86,p = 0.0001) (Fig. 1) without significant heterogeneity (RCT I 2 = 0%; cohort I 2 = 0%).For secondary outcomes, dexmedetomidine failed to decrease postoperative mortality (RCT RR 0.20, 95% CI 0.02-1.68;cohort RR 0.56, 95% CI 0.28-1.15),duration of mechanical ventilator (RCT standard mean differences [SMD] -0.18, 95% CI -2.08-1.71;cohort SMD -0.12, 95% CI -0.25-0.01),intensive care unit stay (RCT SMD -0.21, 95% CI -0.53-0.11;cohort SMD -0.52, 95% CI -1.06-0.02),and hospital length of stay (SMD -0.34, 95% CI -1.21-0.54).However, decreased trends were observed for all secondary outcomes.
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Shi et al. (2017) conducted a meta-analysis in Cardiac surgery-associated acute kidney injury (CSA-AKI) (n=19,604). Dexmedetomidine vs. Placebo or Control was evaluated on Incidence of CSA-AKI (RR 0.44, 95% CI 0.26-0.76, p=0.003). Dexmedetomidine significantly reduced the incidence of cardiac surgery-associated acute kidney injury in both randomized controlled trials (RR 0.44) and cohort studies (RR 0.74).
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