Effect of intraoperative dexmedetomidine on renal function after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: a randomized, placebo-controlled trial
Introduction: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) predispose to postoperative renal dysfunction. Dexmedetomidine is an α2 adrenoreceptor agonist, which has renoprotective effects after cardiac surgery. Objective: To assess the effect of dexmedetomidine o...
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doaj-89c4352b597b4c53b0f69f627204191e2020-11-25T02:34:05ZengTaylor & Francis GroupInternational Journal of Hyperthermia0265-67361464-51572019-01-013611810.1080/02656736.2018.15264161526416Effect of intraoperative dexmedetomidine on renal function after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: a randomized, placebo-controlled trialYoung Song0Do-Hyeong Kim1Tae Dong Kwon2Dong Woo Han3Seung Hyuk Baik4Hwan Ho Jung5Ji Young Kim6Yonsei University College of MedicineYonsei University College of MedicineYonsei University College of MedicineYonsei University College of MedicineYonsei University College of MedicineYonsei University College of MedicineYonsei University College of MedicineIntroduction: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) predispose to postoperative renal dysfunction. Dexmedetomidine is an α2 adrenoreceptor agonist, which has renoprotective effects after cardiac surgery. Objective: To assess the effect of dexmedetomidine on renal function after CRS and HIPEC. Materials: Thirty-eight patients undergoing CRS and HIPEC were randomized to receive dexmedetomidine (dexmedetomidine group, n = 19, loading 1 μg/kg over 20 min followed by infusion at 0.5 μg/kg/h) or 0.9% sodium chloride (control group, n = 19) during surgery. Creatinine clearance (CrCl) was assessed daily until postoperative day 7. Urine neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule (KIM)-1 were measured for 24 h after surgery. Results: There was no difference in the lowest CrCl value during the first 7 days postoperatively, but the % change from baseline to the lowest value was lower in the dexmedetomidine group than in the control group (p = .037). Urine NGAL and KIM-1 levels were increased over time in both groups, but the increases were significantly less in the dexmedetomidine group (p = .018 and 0.038, respectively). In the dexmedetomidine group, the length of intensive care unit stay was shorter (p = .034). Conclusions: Intraoperative dexmedetomidine infusion did not improve renal function in terms of serum Cr-related indices following CRS and HIPEC. However, as the decrease in CrCl was attenuated and early tubular-injury markers were lower in the dexmedetomidine group, dexmedetomidine may have protective effects against early tubular injury in CRS and HIPEC. Clinical Trials Registry: http://clinicaltrials.gov (NCT02641938).http://dx.doi.org/10.1080/02656736.2018.1526416cytoreductive surgical procedureshyperthermiadexmedetomidineacute kidney injury |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Young Song Do-Hyeong Kim Tae Dong Kwon Dong Woo Han Seung Hyuk Baik Hwan Ho Jung Ji Young Kim |
spellingShingle |
Young Song Do-Hyeong Kim Tae Dong Kwon Dong Woo Han Seung Hyuk Baik Hwan Ho Jung Ji Young Kim Effect of intraoperative dexmedetomidine on renal function after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: a randomized, placebo-controlled trial International Journal of Hyperthermia cytoreductive surgical procedures hyperthermia dexmedetomidine acute kidney injury |
author_facet |
Young Song Do-Hyeong Kim Tae Dong Kwon Dong Woo Han Seung Hyuk Baik Hwan Ho Jung Ji Young Kim |
author_sort |
Young Song |
title |
Effect of intraoperative dexmedetomidine on renal function after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: a randomized, placebo-controlled trial |
title_short |
Effect of intraoperative dexmedetomidine on renal function after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: a randomized, placebo-controlled trial |
title_full |
Effect of intraoperative dexmedetomidine on renal function after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: a randomized, placebo-controlled trial |
title_fullStr |
Effect of intraoperative dexmedetomidine on renal function after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: a randomized, placebo-controlled trial |
title_full_unstemmed |
Effect of intraoperative dexmedetomidine on renal function after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: a randomized, placebo-controlled trial |
title_sort |
effect of intraoperative dexmedetomidine on renal function after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: a randomized, placebo-controlled trial |
publisher |
Taylor & Francis Group |
series |
International Journal of Hyperthermia |
issn |
0265-6736 1464-5157 |
publishDate |
2019-01-01 |
description |
Introduction: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) predispose to postoperative renal dysfunction. Dexmedetomidine is an α2 adrenoreceptor agonist, which has renoprotective effects after cardiac surgery. Objective: To assess the effect of dexmedetomidine on renal function after CRS and HIPEC. Materials: Thirty-eight patients undergoing CRS and HIPEC were randomized to receive dexmedetomidine (dexmedetomidine group, n = 19, loading 1 μg/kg over 20 min followed by infusion at 0.5 μg/kg/h) or 0.9% sodium chloride (control group, n = 19) during surgery. Creatinine clearance (CrCl) was assessed daily until postoperative day 7. Urine neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule (KIM)-1 were measured for 24 h after surgery. Results: There was no difference in the lowest CrCl value during the first 7 days postoperatively, but the % change from baseline to the lowest value was lower in the dexmedetomidine group than in the control group (p = .037). Urine NGAL and KIM-1 levels were increased over time in both groups, but the increases were significantly less in the dexmedetomidine group (p = .018 and 0.038, respectively). In the dexmedetomidine group, the length of intensive care unit stay was shorter (p = .034). Conclusions: Intraoperative dexmedetomidine infusion did not improve renal function in terms of serum Cr-related indices following CRS and HIPEC. However, as the decrease in CrCl was attenuated and early tubular-injury markers were lower in the dexmedetomidine group, dexmedetomidine may have protective effects against early tubular injury in CRS and HIPEC. Clinical Trials Registry: http://clinicaltrials.gov (NCT02641938). |
topic |
cytoreductive surgical procedures hyperthermia dexmedetomidine acute kidney injury |
url |
http://dx.doi.org/10.1080/02656736.2018.1526416 |
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