DataSheet1_Correlation between perioperative dexmedetomidine administration and postoperative acute kidney injury in hypertensive patients undergoing non-cardiac surgery.PDF

Background: Previous studies have suggested that dexmedetomidine may have a protective effect on renal function. However, it is currently unclear whether perioperative dexmedetomidine administration is associated with postoperative acute kidney injury (AKI) incidence risk in hypertensive patients undergoing non-cardiac surgery.
Methods: This investigation was a retrospective cohort study. Hypertensive patients undergoing non-cardiac surgery in Third Xiangya Hospital of Central South University from June 2018 to December 2019 were included. The relevant data were extracted through electronic cases. The univariable analysis identified demographic, preoperative laboratory, and intraoperative factors associated with acute kidney injury. Multivariable stepwise logistic regression was used to assess the association between perioperative dexmedetomidine administration and postoperative acute kidney injury after adjusting for interference factors. In addition, we further performed sensitivity analyses in four subgroups to further validate the robustness of the results.
Results: A total of 5769 patients were included in this study, with a 7.66% incidence of postoperative acute kidney injury. The incidence of postoperative acute kidney injury was lower in the dexmedetomidine-administered group than in the control group (4.12% vs. 8.06%, p < 0.001). In the multivariable stepwise logistic regression analysis, perioperative dexmedetomidine administration significantly reduced the risk of postoperative acute kidney injury after adjusting for interference factors [odds ratio (OR) = 0.56, 95% confidence interval (CI): 0.36–0.87, p = 0.010]. In addition, sensitivity analysis in four subgroups indicated parallel findings: i) eGRF <90 mL/min·1.73/m2 subgroup (OR = 0.40, 95% CI: 0.19–0.84, p = 0.016), ii) intraoperative blood loss <1000 mL subgroup (OR = 0.58, 95% CI: 0.36–0.94, p = 0.025), iii) non-diabetes subgroup (OR = 0.51, 95% CI: 0.29–0.89, p = 0.018), and iv) older subgroup (OR = 0.55, 95% CI: 0.32–0.93, p = 0.027).
Conclusion: In conclusion, our study suggests that perioperative dexmedetomidine administration is associated with lower risk and less severity of postoperative acute kidney injury in hypertensive individuals undergoing non-cardiac surgery. Therefore, future large-scale RCT studies are necessary to validate this benefit.

背景：既往研究显示，右美托咪定（dexmedetomidine）对肾功能可能具有保护作用。但目前尚不明确，接受非心脏手术的高血压患者围手术期使用右美托咪定，是否与术后急性肾损伤（acute kidney injury, AKI）的发生风险相关。
方法：本研究为回顾性队列研究。纳入2018年6月至2019年12月期间，于中南大学湘雅三医院接受非心脏手术的高血压患者。通过电子病历系统提取相关临床数据。采用单因素分析筛选出与急性肾损伤相关的人口学特征、术前实验室指标及术中相关因素。通过多因素逐步logistic回归模型，在校正混杂因素后，评估围手术期使用右美托咪定与术后急性肾损伤的关联。此外，本研究进一步开展4个亚组的敏感性分析，以验证研究结果的稳健性。
结果：本研究共纳入5769例患者，术后急性肾损伤总体发生率为7.66%。使用右美托咪定的观察组术后急性肾损伤发生率显著低于对照组（4.12% vs. 8.06%，p < 0.001）。多因素逐步logistic回归分析显示，在校正混杂因素后，围手术期使用右美托咪定可显著降低术后急性肾损伤的发生风险[比值比（odds ratio, OR）= 0.56，95%置信区间（confidence interval, CI）：0.36–0.87，p = 0.010]。此外，4个亚组的敏感性分析得到了一致的结果：①估算肾小球滤过率（eGRF）<90 mL/min·1.73/m²亚组（OR = 0.40，95%CI：0.19–0.84，p = 0.016）；②术中失血量<1000 mL亚组（OR = 0.58，95%CI：0.36–0.94，p = 0.025）；③非糖尿病亚组（OR = 0.51，95%CI：0.29–0.89，p = 0.018）；④老年亚组（OR = 0.55，95%CI：0.32–0.93，p = 0.027）。
结论：综上，本研究表明，对于接受非心脏手术的高血压患者，围手术期使用右美托咪定可降低术后急性肾损伤的发生风险并减轻其严重程度。因此，未来需开展大规模随机对照试验（randomized controlled trial, RCT）以验证这一临床获益。