Effect of intraoperative dexmedetomidine on renal function after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: a randomized, placebo-controlled trial
Young Song, Do-Hyeong Kim, Tae Dong Kwon, Dong Woo Han, Seung Hyuk Baik, Hwan Ho Jung, Ji Young Kim, Young Song, Do-Hyeong Kim, Tae Dong Kwon, Dong Woo Han, Seung Hyuk Baik, Hwan Ho Jung, Ji Young Kim
Abstract
Introduction: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) predispose to postoperative renal dysfunction. Dexmedetomidine is an α2 adrenoreceptor agonist, which has renoprotective effects after cardiac surgery.
Objective: To assess the effect of dexmedetomidine on renal function after CRS and HIPEC.
Materials: Thirty-eight patients undergoing CRS and HIPEC were randomized to receive dexmedetomidine (dexmedetomidine group, n = 19, loading 1 μg/kg over 20 min followed by infusion at 0.5 μg/kg/h) or 0.9% sodium chloride (control group, n = 19) during surgery. Creatinine clearance (CrCl) was assessed daily until postoperative day 7. Urine neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule (KIM)-1 were measured for 24 h after surgery.
Results: There was no difference in the lowest CrCl value during the first 7 days postoperatively, but the % change from baseline to the lowest value was lower in the dexmedetomidine group than in the control group (p = .037). Urine NGAL and KIM-1 levels were increased over time in both groups, but the increases were significantly less in the dexmedetomidine group (p = .018 and 0.038, respectively). In the dexmedetomidine group, the length of intensive care unit stay was shorter (p = .034).
Conclusions: Intraoperative dexmedetomidine infusion did not improve renal function in terms of serum Cr-related indices following CRS and HIPEC. However, as the decrease in CrCl was attenuated and early tubular-injury markers were lower in the dexmedetomidine group, dexmedetomidine may have protective effects against early tubular injury in CRS and HIPEC. Clinical Trials Registry: https://ichgcp.net/clinical-trials-registry/NCT02641938" title="See in ClinicalTrials.gov">NCT02641938).
Keywords: Cytoreductive surgical procedures; acute kidney injury; dexmedetomidine; hyperthermia.
Source: PubMed