Acute kidney injury(AKI) is a common and severe complication after the cardiac surgery. Postoperative AKI increases the in-hospital stay, intensive care unit(ICU) stay and postoperative mortality. Aortic surgery is the most risky surgery that causes the postoperative AKI, and the incidence of AKI after aortic surgery is about 50%. The α1- and α2-adrenergic receptors in the kidney modulate vasoconstrictor and vasodilatory effects, respectively. Agents that attenuate renal vasoconstriction may have potential as renoprotective drugs because vasoconstriction most likely contributes to the pathophysiology of AKI. Clonidine, an α2-agonist, has been shown experimentally to inhibit renin release and cause a diuresis, and it has been evaluated in an experimental AKI model, confirming its potential as a renoprotective agent. Furthermore, it has been already reported that dexmedetomidine, α2-agonist, reduce the impairment of renal function after cardiac operation. The aim of this study is to examine the association between preoperative dexmedetomidine infusion and the incidence of postoperative acute kidney injury(AKI) in patients undergoing aortic surgery.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
QUADRUPLE
Enrollment
108
Immediately after the induction of anesthesia, patients in the dexmedetomidine group received dexmedetomidine continuous intravenous (IV) infusion of 0.4 mcg/kg/h until 24 hours after surgery.
same infusion rate (received equal volume of normal saline), IV, The infusion of study drug is started after anesthesia induction and continued until 24 hours after surgery.
Department of Anesthesiology and Pain Medicine, Yonsei Cardiovascular Hospital, Yonsei University College of Medicine
Seoul, South Korea
Acute kidney injury (AKI) after aortic surgery (AKI according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria)
0.3 mg/dl increase in serum creatinine concentration within 48 hours OR, a 50% increase within 7 days postoperatively OR, urine volume \< 0.5 ml/kg/h for 6 hours
Time frame: up to 7 days after the aortic surgery
Acute kidney injury (AKI) after aortic surgery (AKI according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria)
KDIGO stage 2: Serum creatinine increase to 2-3-fold from baseline OR urine output \< 0.5 ml/kg/h for 12h
Time frame: up to 7 days after the surgery
Acute kidney injury (AKI) after aortic surgery (AKI according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria)
KDIGO stage 3: Serum creatinine increase to 3.0-fold from baseline OR Increase in serum creatinine to ≥ 4 mg/dl OR Initiation of renal replacement therapy OR In patients \<18 years, decrease in eGFR to \< 35 ml/min per 1.73 m2 OR Anuria for ≥ 12h.
Time frame: up to 7 days after the surgery
major morbidity endpoint
acute kidney injury (same as the primary endpoint), permanent stroke, prolonged ventilator care \>24h, deep wound infection, and mortality.
Time frame: acute kidney injury - up to 7 days after the surgery; Other - during the hospitalization for surgery
postoperative delirium
delirium - assessed with The American Psychiatric Association's fifth edition of the Diagnostic and Statistical Manual of Mental Disorders or Confusion Assessment Method for the ICU
Time frame: up to 7 days after the surgery
drug-related adverse events
hypotension (mean arterial pressure \<60 mmHg) or bradycardia (\<50 beats/min) OR the use of vasopressor, inotropes or temporary pacing, OR postoperative arrhythmia
Time frame: hypotension or bradycardia: during surgery; Other - during surgery and 24 hours after surgery
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