Perioperative dexmedetomidine administration does not reduce the risk of acute kidney injury after non-cardiac surgery:a meta-analysis

Background:Post-operative acute kidney injury(AKI)is one of the most common and serious complications after major surgery and is significantly associated with increased risks of morbidity and mortality.This meta-analysis was conducted to evaluate the effects of perioperative dexmedetomidine(Dex)administration on the occurrence of AKI and the outcomes of recovery after non-cardiac surgery.Methods:The PubMed,Embase,Web of Science,and Cochrane Library databases were systematically searched for studies comparing the effects of Dexvs.placebo on kidney function after non-cardiac surgery,and a pooled fixed-effect meta-analysis of the included studies was performed.The primary outcome was the occurence of post-operative AKI.The secondary outcomes included the occurence of intra-operative hypotension and bradycardia,intensive care unit(ICU)admission,duration of ICU stay,and hospital length of stay(LOS).Results:Six studies,including four randomized controlled trials(RCTs)and two observational studies,with a total of 2586 patients were selected.Compared with placebo,Dex administration could not reduce the odds of post-operative AKI(odds ratio[OR],0.44;95%confidence interval(CI),0.18-1.06;P=0.07;I^(2)=0.00%,P=0.72)in RCTs,but it showed a significant renoprotective effect(OR,0.67;95%CI,0.48-0.95;P=0.02;I^(2)=0.00%,P=0.36)in observational studies.Besides,Dex administration significantly increased the odds of intra-operative bradycardia and shortened the duration of ICU stay.However,there was no significant difference in the odds of intra-operative hypotension,ICU admission,and hospital LOS.Conclusions:This meta-analysis suggests that perioperative Dex administration does not reduce the risk of AKI after non-cardiac surgery.However,the quality of evidence for this result is low due to imprecision and inconsistent types of non-cardiac operations.Thus,large and high-quality RCTs are needed to verify the real effects of perioperative Dex administration on the occurrence of AKI and the outcomes of recovery after non-cardiac surgery.