Abstract
Objective: Acute kidney injury in major surgery is associated with increased postoperative mortality. This study aimed to evaluate renal function after major urologic surgery and intraoperative dexmedetomidine infusion. Methods: Thirty oncologic patients with normal renal function scheduled for prostatectomy or nephrectomy, anesthetized with combined epidural and general anesthesia, were randomized to receive either intraoperative blind infusion of dexmedetomidine (Dexmedetomidine Group, n = 15, 0.5 μg/kg load dose plus 0.7 μg/kg/h) or 0.9% saline (Control Group, n = 15) until the end of surgery. Intraoperative and cumulative 24-hour diuresis, serum creatinine (SCr), calculated creatinine clearance (ClCr) and serum cystatin C (SCys) at postoperative days 1, 2 and 3 and 2 weeks after surgery were evaluated. Results: Mean ± standard deviation values for intraoperative diuresis in Dexmedetomidine and Control Groups were 566 ± 396 mL and 298 ± 153 mL, respectively (p = 0.014). Cumulative 24-hour diuresis in Dexmedetomidine and Control Groups was 1947 ± 266 mL and 1748 ± 237 mL, respectively (p = 0.91). Mean values of SCr, ClCr and SCys were not significantly different from their baseline values in both groups and no significant differences were seen between groups at any moment for two weeks (p > 0.05). Conclusion: According to the doses used in this study, despite an intraoperative increase in diuresis, intraoperative infusion of dexmedetomidine did not influence renal performance up to two weeks after major uro-oncologic surgery, as evaluated by SCr, ClCr and SCys.
Highlights
Acute kidney injury (AKI) is usually seen in the perioperative period, mainly after major surgeries [1]
According to the doses used in this study, despite an intraoperative increase in diuresis, intraoperative infusion of dexmedetomidine did not influence renal performance up to two weeks after major uro-oncologic surgery, as evaluated by serum creatinine (SCr), ClCr and serum cystatin C (SCys)
No significant changes were seen in postoperative mean values of serum creatinine and creatinine clearance for both, Dexmedetomidine Group and Control Group, according to their baseline values
Summary
Acute kidney injury (AKI) is usually seen in the perioperative period, mainly after major surgeries [1]. It has been observed that postoperative elevated values of serum creatinine are associated with increases in time and cost of hospital stay and with high rates of morbidity and mortality [2]. Urological procedures are considered to be of high risk for the development of perioperative kidney injury [3], and nephrectomy has the highest potential to cause AKI [4]. Several strategies are used to either prevent or minimize perioperative AKI. These can be either pharmacological or nonpharmacological strategies, even involving early dialysis techniques [5]. Alone or in combination, was shown to be effective in preventing perioperative AKI until the present time [7]
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