Effect of Dexmedetomidine on Cardiac Surgery-Associated Acute Kidney Injury: A Meta-Analysis With Trial Sequential Analysis of Randomized Controlled Trials

Q: What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Cardiac surgery-associated acute kidney injury (n=1308). Intervention: Dexmedetomidine vs. Control group (saline or other sedatives). Primary outcome: Incidence of postoperative acute kidney injury (CS-AKI) (RR 0.60, 95% CI 0.41-0.87, p=0.008).

Key Result

Dexmedetomidine reduced the incidence of postoperative acute kidney injury by 40% compared to controls in adult patients undergoing cardiac surgery.

Study Design

Type

Meta-Analysis (n=1,308)

Structured PICO

Does perioperative dexmedetomidine reduce the incidence of postoperative acute kidney injury in adult patients undergoing cardiac surgery?

Population

9 RCTs pooling 1,308 adult patients undergoing nonemergency cardiac surgeries (primary elective coronary artery bypass graft, and/or valve replacement procedures on cardiopulmonary bypass).

Intervention

Perioperative dexmedetomidine (0.1-0.8 mcg/kg/h continuous infusion) initiated before, during, or after surgery.

Comparator

Control group receiving saline or other sedatives/analgesics.

Outcome

Incidence of postoperative cardiac surgery-associated acute kidney injury (CS-AKI) based on criteria used in each original study.hard clinical

Perioperative dexmedetomidine administration significantly reduces the risk of acute kidney injury in adult patients undergoing cardiac surgery, particularly when initiated before or during surgery.

Main Result

Effect estimate: RR 0.60 (95% CI 0.41-0.87)

Absolute Event Rate: 10.9% vs 18.3%

p-value: p=0.008

Limitations

Lack of intention-to-treat analysis in included studies.
Risk of bias due to non-uniformity in AKI definitions across studies.
Small sample size may limit the ability to detect differences in secondary outcomes.

Abstract

Perioperative DEX administration provided protective effects against CS-AKI, especially when initiated before and during surgery in elderly patients.

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Cite This Study

Peng et al. (Mon,) conducted a meta-analysis in Cardiac surgery-associated acute kidney injury (n=1,308). Dexmedetomidine vs. Control group (saline or other sedatives) was evaluated on Incidence of postoperative acute kidney injury (CS-AKI) (RR 0.60, 95% CI 0.41-0.87, p=0.008). Dexmedetomidine reduced the incidence of postoperative acute kidney injury by 40% compared to controls in adult patients undergoing cardiac surgery.

synapsesocial.com/papers/696fb324ad5d837fc69c15a0 https://doi.org/https://doi.org/10.1053/j.jvca.2019.09.011

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