The Effect of Dexmedetomidine on Postoperative Acute Kidney Injury in High-Risk Partial Nephrectomy Patients: A...

Randomized controlled trial has shown that dexmedetomidine does not significantly reduce postoperative acute kidney injury (AKI) in general partial nephrectomy (PN) populations. However, evidence remains limited in patients with high susceptibility to renal ischemia, such as those with a solitary kidney or pre-existing chronic kidney disease (CKD).

We conducted a single-center retrospective cohort study including adult high-risk PN patients between 2015 and 2023. Eligible high-risk patients were those with a solitary kidney or pre-existing CKD. The study cohort was divided into dexmedetomidine-exposed and non-exposed groups. To balance baseline characteristics, inverse probability of treatment weighting (IPTW) was applied. The primary outcome was AKI incidence within 24 hours postoperatively, defined by KDIGO creatinine criteria.

The study included 274 patients, with 82 assigned to the dexmedetomidine-exposed cohort and 192 to the non-exposed cohort. After IPTW adjustment, all baseline covariates were well balanced. Dexmedetomidine exposure was associated with significantly lower AKI incidence (23.9% versus 38.6%, P = 0.025), with a trend toward milder AKI staging. Intraoperative urine output was higher in the dexmedetomidine group (341 ± 183 versus 282 ± 188 mL, P = 0.022). Length of postoperative hospital stay, postoperative complications, ICU admission rate, percentage decrease in eGFR from baseline at 6-month follow-up, and incidence of a >20% decrease from baseline eGFR at 6-month follow-up did not differ significantly between the two groups.

In high-risk PN patients with a solitary kidney or pre-existing CKD, intraoperative dexmedetomidine was associated with a clinically meaningful reduction in postoperative AKI. These findings suggest a potential renoprotective role of dexmedetomidine in this vulnerable surgical population, although this early renal benefit did not translate into long-term improvements in renal function.