Dexmedetomidine and acute kidney injury after non-cardiac surgery: A meta-analysis with trial sequential analysis

Kai Zhuang; Hao-Tian Yang; Yu-Qin Long; Hong Liu; Fu-Hai Ji; Ke Peng

doi:10.1016/j.accpm.2024.101359

Dexmedetomidine and acute kidney injury after non-cardiac surgery: A meta-analysis with trial sequential analysis

Anaesth Crit Care Pain Med. 2024 Feb 21;43(3):101359. doi: 10.1016/j.accpm.2024.101359. Online ahead of print.

Authors

Kai Zhuang¹, Hao-Tian Yang¹, Yu-Qin Long¹, Hong Liu², Fu-Hai Ji¹, Ke Peng³

Affiliations

¹ Department of Anaesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China; Institute of Anaesthesiology, Soochow University, Suzhou, Jiangsu, China.
² Department of Anaesthesiology and Pain Medicine, University of California Davis Health, Sacramento, CA, USA.
³ Department of Anaesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China; Institute of Anaesthesiology, Soochow University, Suzhou, Jiangsu, China. Electronic address: pengke0422@163.com.

PMID: 38395357
DOI: 10.1016/j.accpm.2024.101359

Abstract

Background: Acute kidney injury (AKI) is a common complication after surgery and is associated with detrimental outcomes. This systematic review and meta-analysis evaluated perioperative dexmedetomidine on AKI and renal function after non-cardiac surgery.

Methods: PubMed, Embase, and Cochrane Library databases were searched until August 2023 for randomised trials comparing dexmedetomidine with normal saline on AKI and renal function in adults undergoing non-cardiac surgery. The primary outcome was the incidence of AKI (according to Kidney Disease Improving Global Outcomes or Acute Kidney Injury Network criteria). Meta-analysis was performed using a random-effect model. We conducted sensitivity analysis, trial sequential analysis (TSA), and Grading of Recommendations Assessment, Development and Evaluation level of evidence.

Results: Twenty-three trials involving 2440 patients were included. Dexmedetomidine administration, as compared to normal saline, significantly reduced the incidence of AKI (7.4% vs. 13.2%; risk ratio = 0.57, 95% CI = 0.40-0.83, P = 0.003, I² = 0%; a high level of evidence); TSA and sensitivity analyses suggested the robustness of this outcome. For the renal function and inflammation parameters, dexmedetomidine decreased serum creatinine, blood urea nitrogen, cystatin C, tumour necrosis factor-α, and interleukin-6, and increased urine output and estimated glomerular filtration rate. Additionally, dexmedetomidine reduced postoperative nausea and vomiting and length of hospital stay. Dexmedetomidine was associated with an increased rate of bradycardia, but not hypotension.

Conclusion: Dexmedetomidine administration reduced the incidence of AKI and improved renal function after non-cardiac surgery. Based on a high level of evidence, dexmedetomidine is recommended as a component of perioperative renoprotection.

Registration: International Prospective Register of Systematic Reviews; Registration number: CRD42022299252.

Keywords: Acute kidney injury; Dexmedetomidine; Meta-analysis; Non-cardiac surgery; Renal function.

Publication types

Review