Dexmedetomidine on the Prognosis of Patients With Sepsis-related Acute Kidney Injury

Abstract

 Introduction. To investigate the effect of dexmedetomidine (DEX) 
on the prognosis and renal function recovery in patients with 
sepsis-associated AKI (SA-AKI).
 Methods. A prospective observational study was conducted, 
enrolling patients with SA-AKI admitted to the ICU of Suzhou 
Municipal Hospital from July 2021 to June 2023. Patients were 
divided into a DEX group and a non-DEX group according to 
the sedation regimen. 
Results. After matching, a total of 204 patients (102 in each 
group) were included, with balanced baseline (SMD < 10%). The 
primary endpoint: DEX significantly reduced the risk of 28-day 
mortality (adjusted HR = 0.556, 95% CI:0.317 to 0.975; P = .041), 
with a particularly significant benefit in patients with non
septic shock (HR = 0.372, P = .016) and AKI stage 1 (HR = 0.375, 
P = .035). Secondary endpoints: DEX significantly improved the 
rate of renal function recovery (adjusted OR = 2.841, 95% CI:1.427 
to 5.656; P = .003), and the efficacy was modified by AKI stage 
(P-interaction = .005) and shock status (P-interaction = .006). The 
benefit was most prominent in patients with AKI stage 1 (P = .009) 
; the benefit was clear in patients with non-septic shock (P = .011). 
There was a strong trend toward benefit in patients with septic 
shock (P = .054). There was no difference in ICU length of stay 
between the two groups (P > .05).
 Conclusions. DEX significantly improves survival and promotes 
renal function recovery in patients with SA-AKI, particularly in 
patients with stage 1 AKI and non-septic shock. The potentially 
significant benefit observed in patients with septic shock warrants 
further validation in a larger sample.