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

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
DOI: 10.1038/ki.2015.306 Publication Date: 2015-10-07T15:56:12Z
ABSTRACT
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.
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