The effect of dexmedetomidine on renal function after surgery: A systematic review and meta-analysis

被引:25
作者
Loomba, Rohit S. [1 ,2 ]
Villarreal, Enrique G. [3 ]
Dhargalkar, Janhavi [2 ]
Rausa, Jacqueline [1 ]
Dorsey, Vincent [1 ]
Farias, Juan S. [3 ]
Flores, Saul [4 ,5 ]
机构
[1] Advocate Childrens Hosp, Div Cardiol, Oak Lawn, IL USA
[2] Rosalind Franklin Univ Med & Sci, Chicago Med Sch, Dept Pediat, N Chicago, IL USA
[3] Tecnol Monterrey, Escuela Med Cie Salud, Av Morones Prieto 3000,Colonia Doctores, Monterrey, Nuevo Leon, Mexico
[4] Texas Childrens Hosp, Sect Crit Care Med & Cardiol, Houston, TX 77030 USA
[5] Baylor Sch Med, Dept Pediat, Houston, TX USA
关键词
acute kidney injury; blood urea nitrogen; creatinine; dexmedetomidine; length of stay; postoperative complications; ACUTE KIDNEY INJURY; INTRAOPERATIVE DEXMEDETOMIDINE; CARDIAC-SURGERY; DOUBLE-BLIND; COSTS; PROTECTS; OUTCOMES; BYPASS;
D O I
10.1111/jcpt.13527
中图分类号
R9 [药学];
学科分类号
1007 ;
摘要
What is known and objective Acute kidney injury (AKI) is a complication following surgery and has been associated with worsened patient outcomes. Providers have used agents that may confer a degree of renal protection in the perioperative stage. Such is the case of dexmedetomidine, a selective alpha-2 adrenergic agonist used in the intensive care unit (ICU) as a sedative agent. The primary objective of this meta-analysis was to characterize the use of dexmedetomidine and to evaluate its impact on renal markers and outcomes in patients after surgery. Methods A systematic review of manuscripts was performed to identify patients who received dexmedetomidine after surgery by searching the PubMed, Embase, and Cochrane databases. The following parameters were captured: blood urea nitrogen (BUN), serum creatinine, creatinine clearance, neutrophil gelatinase-associated lipoprotein (NGAL), cystatin C, urine output, duration of mechanical ventilation, ICU length of stay, AKI, need for dialysis, and mortality. Results and Discussion Nineteen studies with 3,395 patients were included in the analyses. The mean bolus and infusion dose of dexmedetomidine were 0.82 mu g/kg and 0.54 mcg/kg/hr, respectively. There was a significant difference in creatinine clearance and NGAL in favour of the dexmedetomidine group. In addition, the dexmedetomidine group had a shorter ICU length of stay, and a lower risk of acute kidney injury and mortality compared to the control. There was no difference in the rest of the parameters. What is new and conclusion Dexmedetomidine appears to have postoperative renal protective effects. This is evidenced by lower NGAL levels and increased creatinine clearance in those who received dexmedetomidine. These effects are associated with decreases in ICU length of stay and risk of AKI and mortality.
引用
收藏
页码:287 / 297
页数:11
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