La dexmedetomidina mitiga la insuficiencia renal aguda tras la cirugía de revascularización coronaria: un ensayo clínico prospectivo

Abstract

Introduction and objectives

To evaluate the impact of dexmedetomidine impact on cardiac surgery-associated acute kidney injury (CSA-AKI), kidney function, and metabolic and oxidative stress in patients undergoing coronary artery bypass grafting with heart-lung machine support.

Methods

A randomized double-masked trial with 238 participants (50-75 years) undergoing coronary artery bypass grafting was conducted from January 2021 to December 2022. The participants were divided into Dex (n = 119) and NS (n = 119) groups. Dex was administered at 0.5 mcg/kg over 10 minutes, then 0.4 mcg/kg/h until the end of surgery; the NS group received equivalent saline. Blood and urine were sampled at various time points pre- and postsurgery. The primary outcome measure was the incidence of CSA-AKI, defined as the occurrence of AKI within 96 hours after surgery.

Results

The incidence of CSA-AKI was significantly lower in the Dex group than in the NS group (18.26% vs 32.46%; P = .014). Substantial increases were found in estimated glomerular filtration rate value at T4–T6 (P < .05) and urine volume 24 hours after surgery (P < .01). Marked decreases were found in serum creatinine level, blood glucose level at T1–T2 (P < .01), blood urea nitrogen level at T3–T6 (P < .01), free fatty acid level at T2–T3 (P < .01), and lactate level at T3–T4 (P < .01).

Conclusions

Dex reduces CSA-AKI, potentially by regulating metabolic disorders and reducing oxidative stress.

Registered with the Chinese Clinical Study Registry (No. ChiCTR2100051804).