Dexmedetomidine reduces cardiac surgery-associated AKI by reducing oxidative stress: Study

Cardiac surgery-associated acute kidney injury is a well-recognized complication resulting in higher mortality-morbidity after cardiac surgery. In its most severe form, it increases the odds ratio of operative mortality 3–8-fold, length of stay in the Intensive Care Unit (ICU) and hospital, and care costs. Early diagnosis is important for the optimal treatment of this complication.

Xiaohong Li, Department of Anesthesiology, First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, China, and colleagues aimed to evaluate the impact of dexmedetomidine on cardiac surgery-associated acute renal failure, kidney function, and oxidative and metabolic stress in patients undergoing coronary artery bypass grafting (CABG) with heart-lung machine support.

For this purpose, they conducted a randomized double-masked trial with 238 participants (50-75 years) undergoing CABG from January 2021 to December 2022. The participants were categorized into Dex (n = 119) and normal saline (NS) groups (n = 119). Dex was administered at 0.5 mcg/kg over 10 minutes, then 0.4 mcg/kg/h until the surgery's end; the NS group received equivalent saline.

Urine and blood sampling were done at several time points pre-and post-surgery. The study's primary outcome measure was the incidence of CSA-AKI, defined as the AKI occurrence within 96 hours after surgery.

The researchers reported the following findings:

• The incidence of CSA-AKI was significantly lower in the Dex group than in the NS group (18.26% vs 32.46%).
• There were substantial increases in the estimated glomerular filtration rate value at T4–T6 and urine volume 24 hours after surgery.
• There were marked decreases in serum creatinine level, blood glucose level at T1–T2, blood urea nitrogen level at T3–T6, free fatty acid level at T2–T3, and lactate level at T3–T4.

In conclusion, dexmedetomidine mitigates acute kidney injury after coronary artery bypass grafting.

"Dexmedetomidine reduces cardiac surgery-associated-acute kidney injury, potentially by reducing oxidative stress and regulating metabolic disorders," the researchers wrote.

Reference:

Zhang, C., Zhang, Y., Liu, D., Mei, M., Song, N., Zhuang, Q., Jiang, Y., Guo, Y., Liu, G., Li, X., & Ren, L. (2024). Dexmedetomidine mitigates acute kidney injury after coronary artery bypass grafting: A prospective clinical trial. Revista Española de Cardiología (English Edition). https://doi.org/10.1016/j.rec.2024.02.005