Effect of perioperative dexmedetomidine on acute kidney injury after partial nephrectomy: a single-centre, randomised, double-blind, placebo-controlled trial.

Abstract

Acute kidney injury (AKI) is a frequent complication after partial nephrectomy. Dexmedetomidine appears to protect against kidney injury in both in vitro and in vivo. We tested the primary hypothesis that perioperative administration of dexmedetomidine would reduce the incidence of postoperative AKI after partial nephrectomy. This randomised, double-blind, placebo-controlled trial was conducted in a tertiary care hospital in Beijing, China with 290 participants randomly assigned to receive dexmedetomidine or saline at a loading dose of 0.6 μg kg^-1 followed by continuous infusion at 0.4 μg kg^-1 h^-1 intraoperatively. Dexmedetomidine (200 μg) was also used as an adjuvant for patient-controlled i.v. analgesia with sufentanil after surgery. The primary outcome was the incidence of AKI, defined according to the creatinine criteria of the KDIGO (Kidney Disease: Improving Global Outcomes) criteria for AKI. Two surgeries were cancelled after randomisation, leaving 288 participants (mean age [range]: 55 [20-79] yr; 32% female) for the modified intention-to-treat analysis. AKI occurred in 32/144 (22%) participants randomly assigned to dexmedetomidine, compared with 33/144 (23%) participants randomly assigned to saline (risk ratio 0.97; 95% confidence interval 0.63-1.49; P=0.888). Secondary outcomes, including postoperative serum cystatin C and serum creatinine levels and estimated glomerular filtration rate in postoperative 6 months, were not different between groups. The incidence of safety outcomes was similar in each group. Perioperative dexmedetomidine administration did not reduce postoperative AKI after partial nephrectomy. ChiCTR2200059536.