Post-bypass dexmedetomidine use and postoperative acute kidney injury in patients undergoing cardiac surgery with cardiopulmonary bypass

Abstract

Background: AND OBJECTIVES: The aim of this retrospective investigation was to study the relationships among chronic kidney disease, acute kidney injury (AKI), and potential benefits by post-bypass dexmedetomidine use in patients undergoing cardiac surgery.

Methods: The patient data were reviewed from the institutional Society of Thoracic Surgeons National Adult Cardiac Surgery Database after IRB approval. 1,133 patients were identified and divided into two groups: those who received dexmedetomidine or those who did not during the post-bypass period. The postoperative outcomes include the incidence of AKI, any complication and all cause of mortality.

Results: Post-bypass dexmedetomidine use was associated with significantly reduced the incidence of total AKI (26.1% vs. 33.75%; adjusted OR, 0.7033; 95%CI, 0.540 to 0.916; p=0.0089). In addition, post-bypass dexmedetomidine use was more likely to reduce the incidence of AKI in these patients with preoperative normal kidney function (Stage1; 32.8% to 22.8%; p=0.0233) and mild CKD (Stage 2; 32.8% to 24.7; p=0.0003) after cardiac surgery. Post-bypass infusion of dexmedetomidine was associated with significantly reduced incidence of any complication and 30-day mortalities.

Conclusions: Post-bypass dexmedetomidine use is associated with a significant reduction in the incidence of AKI, especially mild AKI in patients with preoperative normal renal function and mild CKD undergoing cardiac surgery.

Figure 1. Recruiting of study sample.

Figure 2. Effects of dexmedetomidine on postoperative AKI and other outcomes in patients undergoing cardiac surgery.

Values are numbers (%) for categorical variables and mean± SD for continuous variables. OR, odd ratio; CI, confidence interval; AKIN, acute kidney injury network; AKI, acute kidney injury; RF, renal failure; Post-op, postoperative; eGFR, estimated glomerular filtration rate.

Figure 3. Propensity adjusted risk model for postoperative AKI following cardiac surgery.

Values are n (%) for categorical variables and mean± SD for continuous variables. OR, odd ratio; CI, confidence interval; CKD, chronic kidney disease; CABG, coronary artery bypass graft; BMI, body mass index; Pre-op, preoperative; CHF, congestive heart failure; IABP, intra-aortic balloon pumping.