Intraoperative dexmedetomidine and acute kidney injury in paediatric noncardiac surgery: a retrospective propensity score-matched analysis.

Background: Paediatric acute kidney injury (AKI) is common and linked to longer hospitalisation and mortality. We investigated whether a continuous intraoperative infusion of dexmedetomidine, which increases renal blood flow, was associated with a lower risk of postoperative AKI in paediatric patients undergoing noncardiac surgery.

Methods: This retrospective cohort study included paediatric patients undergoing noncardiac surgery between January 2019 and July 2021. Propensity score matching, based on the participants' baseline characteristics, was used to minimise the potential bias. The primary outcome was AKI within 7 days after surgery. The secondary outcomes included ICU admission, in-hospital mortality, length of hospitalisation, intraoperative bradycardia, and hypotension. The exposure of interest was continuous intraoperative infusion of dexmedetomidine at any dosage or duration. Multivariable logistic regression and linear regression analyses were further used to adjust for residual imbalanced intraoperative factors in the matched cohort.

Results: After propensity score matching, we identified 1858/4091 paediatric patients who had received intraoperative dexmedetomidine infusion. Intraoperative dexmedetomidine infusion was associated with a lower risk of AKI (1.4% vs 3.2%; odds ratio 0.43, 95% confidence interval 0.27-0.66; P<0.001), postoperative ICU admission (odds ratio 0.35, 95% confidence interval 0.30-0.42; P<0.001), and shorter hospitalisation (7 [5-10] vs 9 [6-13] days; P<0.001). Intraoperative bradycardia, hypotension, and in-hospital mortality were similar between the matched groups.

Conclusions: This retrospective analysis of a single-centre paediatric noncardiac surgery cohort suggests that intraoperative dexmedetomidine infusion was associated with a lower incidence of AKI within 7 days after surgery.

Clinical Trial Registration: ChiCTR2300069115.