Prioperative Dexmedetomidine Fails to Prevent AKI After Partial Nephrectomy, suggests study
A recent clinical trial published in the British Journal of Anaesthesia found that the perioperative use of dexmedetomidine did not reduce the incidence of postoperative acute kidney injury (AKI) in patients undergoing partial nephrectomy. Partial nephrectomy is often complicated by AKI, which is characterized by a sudden decline in kidney function. Previous laboratory studies suggested that dexmedetomidine could offer renal protection, but clinical evidence has been limited.
In this trial, the patients were randomly assigned to receive either dexmedetomidine or saline. The treatment protocol included an initial loading dose of 0.6 μg/kg, followed by continuous infusion at 0.4 μg/kg/hour during surgery. Postoperatively, dexmedetomidine (200 μg) was also used as an adjuvant in patient-controlled intravenous analgesia with sufentanil.
After excluding 2 participants whose surgeries were canceled, 288 patients were analyzed. The participants had a mean age of 55 years, with 32% being female. The primary outcome measured was the incidence of postoperative AKI, defined using the KDIGO criteria based on serum creatinine changes.
The results found that AKI occurred in 22% of patients in the dexmedetomidine group when compared to 23% in the placebo group. Statistical analysis indicated no significant difference between groups, with a risk ratio of 0.97 (95% confidence interval 0.63–1.49; P=0.888). Secondary outcomes, including postoperative serum cystatin C and creatinine levels as well as estimated glomerular filtration rates over 6 months, showed no notable differences between the 2 groups.
Safety outcomes were also comparable, with no excess adverse events reported in the dexmedetomidine group. Overall, the trial indicates that while dexmedetomidine is safe for perioperative use, it does not confer protective benefits against kidney injury in the context of partial nephrectomy.
Despite promising laboratory data, the translation of dexmedetomidine’s renal-protective effects into clinical practice remains unproven. Overall, this research highlight the need for continued exploration of alternative interventions to reduce postoperative kidney injury. While dexmedetomidine continues to be valuable for sedation and analgesia during surgery, clinicians should not expect it to reduce the risk of AKI following partial nephrectomy.
Source:
Kong, H., Yin, Q.-L., Li, M., Xu, Z.-Z., Zhang, N., Zhao, X.-N., & Zhang, Z.-Y. (2025). Effect of perioperative dexmedetomidine on acute kidney injury after partial nephrectomy: a single-centre, randomised, double-blind, placebo-controlled trial. British Journal of Anaesthesia. https://doi.org/10.1016/j.bja.2025.08.010
