Perioperative dexmedetomidine and renal outcomes in adult cardiac surgery: an updated systematic review and meta-analysis
Year: 2026
Type: review
Study designs: Systematic Review, Meta-Analysis
Abstract: Background Acute kidney injury (AKI) is a common complication following cardiac surgery, associated with increased morbidity and mortality. Dexmedetomidine (DEX), a highly selective α-2 adrenoceptor agonist, has shown potential renal protective effects, but evidence remains inconsistent. This study aims to evaluate the efficacy of DEX in preventing AKI and improving renal outcomes in cardiac surgery patients through a systematic review and meta-analysis of randomized controlled trials (RCTs). Methods A comprehensive search of PubMed, Cochrane Library, Embase, and Web of Science was conducted until April 2025. PICOS criteria were applied to select studies comparing DEX with placebo/normal saline in cardiac surgery patients. Primary outcomes included AKI incidence; secondary outcomes encompassed intraoperative parameters, postoperative recovery, and complications. Results Bibliometric analysis highlighted China and the USA as leading contributors, with emerging trends in pediatric and mechanistic research. Among 16 RCTs ( n = 2,882), DEX significantly reduced AKI incidence [RR 0.58; 95% CI 0.37 to 0.91; I 2 = 74%, p = 0.02], particularly at 0.6–0.1 μg/kg/h doses [RR 0.43; 95% CI 0.26 to 0.71; I 2 = 0%, p = 0.001]. Subgroup analysis revealed 0.4 μg/kg/h doses failed to yield a statistically significant benefit [RR 0.65; 95% CI 0.36 to 1.17; I 2 = 84%; p = 0.15]. DEX also shortened ICU stay [MD −1.23; 95% CI −2.17 to −0.30; I 2 = 93%; p = 0.01], mechanical ventilation duration [MD −1.24; 95% CI −2.15 to −0.33; I 2 = 97%; p = 0.008], and hospital stays [MD −0.33; 95% CI −0.54 to −0.13; I 2 = 86%; p = 0.01]. However, it did not affect mortality or intraoperative times. Conclusion DEX demonstrates significant renal protection and improves postoperative recovery in cardiac surgery patients, though optimal dosing requires further investigation. These findings support its integration into perioperative protocols but underscore the need for standardized dosing regimens. Systematic review registration Identifier, INPLASY2025120019.
Source: Frontiers in Medicine
Authors: Jie Wen, Fenglin Jiang
Institution: Chengdu University
Language: English
Topic: Acute Kidney Injury Research
Subfield: Nephrology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,801
OpenAlex ID: W7124417292