Does dexmedetomidine reduce the risk of acute kidney injury after cardiac surgery? A meta-analysis of randomized controlled trials
A dexmedetomidina reduz o risco de lesão renal aguda após cirurgia cardíaca? Uma meta-análise de ensaios clínicos randomizados
Chunxiao Zha, Shuo Li, Huiquan Zhan, MengqiGa
Abstract
Background
Acute Kidney Injury (AKI) is a common complication after cardiac surgery and has been associated with poor outcomes. Dexmedetomidine (DEX) has been shown to confer direct renoprotection based on some animal and clinical studies, but data from other trials came to the opposite conclusion following cardiac surgery. This meta-analysis was conducted to evaluate the effects of perioperative DEX administration on the occurrence of AKI and the outcomes after cardiac surgery.
Methods
We searched databases including EMBASE, PubMed, and Cochrane CENTRAL for Randomized Controlled Trials (RCTs) focused on DEX for AKI in adult patients after cardiac surgery. The primary outcome was incidence of AKI. Secondary outcomes were Mechanical Ventilation (MV) duration, Intensive Care Unit (ICU) Length Of Stay (LOS), hospital LOS and mortality.
Results
Fifteen trials enrolling 2907 study patients were collected in the meta-analyses. Compared with controls, DEX reduced the incidence of postoperative AKI (Odds Ratio [OR = 0.66]; 95% Confidence Interval [95% CI 0.48–0.91]; p = 0.01), and there was no significant difference between groups in postoperative mortality (OR = 0.63; 95% CI 0.32–1.26; p = 0.19), MV duration (Weighted Mean Difference [WMD = -0.44]; 95% CI -1.50–0.63; p = 0.42), ICU LOS (WMD = -1.19; 95% CI -2.89–0.51; p = 0.17), and hospital LOS (WMD = -0.31; 95% CI -0.76–0.15; p = 0.19).
Conclusions
Perioperative DEX reduced the incidence of postoperative AKI in adult patients undergoing cardiac surgery. No significant decrease existed in mortality, MV duration, ICU LOS and hospital LOS owing to DEX administration.
Keywords
Resumo
Introdução
Lesão Renal Aguda (LRA) é uma complicação comum após cirurgia cardíaca e tem sido associada a resultados ruins. Foi demonstrado que a dexmedetomidina (DEX) confere renoproteção direta com base em alguns estudos clínicos e em animais, mas dados de outros ensaios chegaram à conclusão oposta após cirurgia cardíaca. Esta meta-análise foi realizada para avaliar os efeitos da administração perioperatória de DEX na ocorrência de LRA e nos resultados após cirurgia cardíaca.
Métodos
Lesão Renal Aguda (LRA) é uma complicação comum após cirurgia cardíaca e tem sido associada a resultados ruins. Foi demonstrado que a dexmedetomidina (DEX) confere renoproteção direta com base em alguns estudos clínicos e em animais, mas dados de outros ensaios chegaram à conclusão oposta após cirurgia cardíaca. Esta meta-análise foi realizada para avaliar os efeitos da administração perioperatória de DEX na ocorrência de LRA e nos resultados após cirurgia cardíaca.
Resultados
Quinze ensaios envolvendo 2.907 pacientes do estudo foram coletados nas meta-análises. Em comparação com os controles, a DEX reduziu a incidência de LRA pós-operatória (Odds Ratio [OR = 0,66]; intervalo de confiança de 95% [IC 95% 0,48–0,91]; p = 0,01), e não houve diferença significativa entre os grupos na mortalidade pós-operatória ( OR = 0,63; IC 95% 0,32–1,26; p = 0,19), duração da VM (diferença média ponderada [DMP = -0,44]; IC 95% -1,50–0,63; p = 0,42), permanência na UTI (DMP = -1,19; IC 95% -2,89–0,51; p = 0,17) e tempo de permanência hospitalar (ADM = -0,31; IC 95% -0,76–0,15; p = 0,19).
Conclusão
A DEX perioperatória reduziu a incidência de LRA pós-operatória em pacientes adultos submetidos à cirurgia cardíaca. Não houve diminuição significativa na mortalidade, duração da VM, permanência na UTI e internação hospitalar devido à administração de DEX.
Palavras-chave
References
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Submitted date:
01/12/2023
Accepted date:
07/03/2023
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