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Perioperative dexmedetomidine reduces the incidence and severity of acute kidney injury following valvular heart surgery

Authors
 Jin Sun Cho  ;  Jae-Kwang Shim  ;  Sara Soh  ;  Min Kyung Kim  ;  Young-Lan Kwak 
Citation
 Kidney International, Vol.89(3) : 693-700, 2016 
Journal Title
 Kidney International 
ISSN
 0085-2538 
Issue Date
2016
MeSH
Acute Kidney Injury/epidemiology ; Acute Kidney Injury/physiopathology ; Acute Kidney Injury/prevention & control* ; Adrenergic alpha-2 Receptor Agonists/administration & dosage* ; Adrenergic alpha-2 Receptor Agonists/adverse effects ; Aged ; Cardiac Surgical Procedures/adverse effects* ; Dexmedetomidine/administration & dosage* ; Dexmedetomidine/adverse effects ; Drug Administration Schedule ; Female ; Heart Valve Diseases/physiopathology ; Heart Valve Diseases/surgery* ; Heart Valves/physiopathology ; Heart Valves/surgery* ; Hemodynamics/drug effects ; Humans ; Incidence ; Infusions, Parenteral ; Length of Stay ; Male ; Middle Aged ; Prospective Studies ; Republic of Korea/epidemiology ; Risk Factors ; Severity of Illness Index ; Time Factors ; Treatment Outcome
Keywords
acute kidney injury ; cardiac surgery ; cardiopulmonary bypass ; dexmedetomidine
Abstract
Acute kidney injury (AKI) following cardiac surgery is closely interrelated with hemodynamic instability and sympathetic activity, and adversely influences prognosis. Here, we investigated in a randomized placebo-controlled trial whether dexmedetomidine, an α2 adrenoreceptor agonist, could prevent AKI after valvular heart surgery. Two hundred patients undergoing valvular heart surgery were randomly assigned to equal placebo or treatment groups. Dexmedetomidine was infused at a rate of 0.4 μg/kg/h starting immediately after anesthetic induction and continuing for 24 h after surgery. We then assessed the incidence of AKI during the first 48 postoperative hours, hemodynamic variables, and a composite of major morbidity end points. The incidence of AKI, based on Acute Kidney Injury Network criteria, was significantly lower in the treatment group compared with the control group (14 vs. 33%). The dexmedetomidine group exhibited a significantly lower incidence of a composite of major morbidity end points (21 vs. 38%) and a significantly shorter length of intensive care unit stay (3 [2, 3] days vs. 3 [2, 4] days) compared with the control group. Thus, perioperative infusion of dexmedetomidine effectively reduced both the incidence and severity of AKI, and improved outcome in patients undergoing valvular heart surgery without untoward hemodynamic side effects.
Full Text
http://www.sciencedirect.com/science/article/pii/S0085253815000344
DOI
10.1038/ki.2015.306
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
Yonsei Authors
곽영란(Kwak, Young Lan) ORCID logo https://orcid.org/0000-0002-2984-9927
소사라(Soh, Sa Rah) ORCID logo https://orcid.org/0000-0001-5022-4617
심재광(Shim, Jae Kwang) ORCID logo https://orcid.org/0000-0001-9093-9692
조진선(Cho, Jin Sun) ORCID logo https://orcid.org/0000-0002-5408-4188
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URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/146374
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