Perioperative dexmedetomidine reduces the incidence and severity of acute kidney injury following valvular heart surgery

• DOI: 10.1038/ki.2015.306
• Publication Date: 2015-10-07T15:56:12Z
• Authors: Jin Sun Cho; Jae-Kwang Shim; Sara Soh; Min Kyung Kim; Young-Lan Kwak
• Keywords: Adrenergic alpha-2 Receptor Agonists/administration & dosage*; Male; Infusions; Time Factors; Heart Valve Diseases; Cardiac Surgical Procedures/adverse effects*; 610; Heart Valves/surgery*; Severity of Illness Index; Drug Administration Schedule; 03 medical and health sciences; Dexmedetomidine/adverse effects; 0302 clinical medicine; Parenteral; Risk Factors; Republic of Korea; Adrenergic alpha-2 Receptor Agonists; Humans; Infusions, Parenteral; Prospective Studies; Acute Kidney Injury/physiopathology; Cardiac Surgical Procedures; Acute Kidney Injury/prevention & control*; Aged; Dexmedetomidine/administration & dosage*; Incidence; Heart Valve Diseases/physiopathology; Hemodynamics; dexmedetomidine; 600; Adrenergic alpha-2 Receptor Agonists/adverse effects; Acute Kidney Injury; Length of Stay; Middle Aged; Heart Valves; Heart Valve Diseases/surgery*; 3. Good health; Hemodynamics/drug effects; Treatment Outcome; acute kidney injury; Female; Republic of Korea/epidemiology; Heart Valves/physiopathology; cardiopulmonary bypass; Acute Kidney Injury/epidemiology; cardiac surgery; Dexmedetomidine

Acute kidney injury (AKI) following cardiac surgery is closely interrelated with hemodynamic instability and sympathetic activity, and adversely influences prognosis. Here, we investigated in a randomized placebo-controlled trial whether dexmedetomidine, an α2 adrenoreceptor agonist, could prevent AKI after valvular heart surgery. Two hundred patients undergoing valvular heart surgery were randomly assigned to equal placebo or treatment groups. Dexmedetomidine was infused at a rate of 0.4 μg/kg/h starting immediately after anesthetic induction and continuing for 24 h after surgery. We then assessed the incidence of AKI during the first 48 postoperative hours, hemodynamic variables, and a composite of major morbidity end points. The incidence of AKI, based on Acute Kidney Injury Network criteria, was significantly lower in the treatment group compared with the control group (14 vs. 33%). The dexmedetomidine group exhibited a significantly lower incidence of a composite of major morbidity end points (21 vs. 38%) and a significantly shorter length of intensive care unit stay (3 [2, 3] days vs. 3 [2, 4] days) compared with the control group. Thus, perioperative infusion of dexmedetomidine effectively reduced both the incidence and severity of AKI, and improved outcome in patients undergoing valvular heart surgery without untoward hemodynamic side effects.