Dexmedetomidine prevents acute kidney injury after adult cardiac surgery: a meta-analysis of randomized controlled trials

Yang Liu, Bo Sheng, Suozhu Wang, Feiping Lu, Jie Zhen, Wei Chen, Yang Liu, Bo Sheng, Suozhu Wang, Feiping Lu, Jie Zhen, Wei Chen

Abstract

Background: Dexmedetomidine has been shown to confer direct renoprotection by stabilizing the sympathetic system, exerting anti-inflammatory effects and attenuating ischemia/reperfusion (I/R) injury in preclinical studies. Results from clinical trials of dexmedetomidine on acute kidney injury (AKI) following adult cardiac surgery are controversial.

Methods: We searched EMBASE, PubMed, and Cochrane CENTRAL databases for randomized controlled trials (RCTs) comparing the renal effect of dexmedetomidine versus placebo or other anesthetic drugs in adult patients undergoing cardiac surgery. The primary outcome was the incidence of AKI. The secondary outcomes were mechanical ventilation (MV) duration, intensive care unit (ICU) stay and hospital length of stay(LOS), and postoperative mortality (in-hospital or within 30 days).

Results: Ten trials with a total of 1575 study patients were selected. Compared with controls, dexmedetomidine significantly reduced the incidence of postoperative AKI [68/788 vs 97/787; odds ratio(OR), 0.65; 95% confidence interval (CI), 0.45-0.92; P = 0.02; I2 = 0.0%], and there was no difference between groups in postoperative mortality (4/487 vs 11/483; OR, 0.43; 95% CI, 0.14-1.28; P = 0.13; I2 = 0.0%), MV duration [in days; n = 1229; weighted mean difference(WMD), -0.22; 95% CI, -2.04 to 1.70; P = 0.81], ICU stay (in days; n = 1363; WMD, -0.85; 95% CI, -2.14 to 0.45; P = 0.20), and hospital LOS (in days; n = 878; WMD, -0.24; 95% CI, -0.71 to 0.23; P = 0.32).

Conclusions: Perioperative administration of dexmedetomidine in adult patients undergoing cardiac surgery may reduce the incidence of postoperative AKI. Future trials are needed to determine the dose and timing of dexmedetomidine in improving outcomes, especially in patients with decreased baseline kidney function.

Keywords: Acute kidney injury; Cardiac surgery; Dexmedetomidine; Meta-analysis.

Conflict of interest statement

Ethics approval and consent to participate

This meta-analysis was approved by the Institutional Review Board in Shijitan Hospital, Capital Medical University, Beijing.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow diagram of studies included into meta-analysis
Fig. 2
Fig. 2
Dexmedetomidine (Dex) reduced the incidence of acute kidney injury
Fig. 3
Fig. 3
Funnel plot assessment of potential publication bias
Fig. 4
Fig. 4
Forest plot for mortality
Fig. 5
Fig. 5
Forest plot for mechanical ventilation duration
Fig. 6
Fig. 6
Forest plot for intensive care unit stay
Fig. 7
Fig. 7
Forest plot for hospital length of stay

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