Safety and Efficacy of Dexmedetomidine in Uremic Patients

Background: Many patients with ESRD require urgent dialysis without preestablished access. Placing a catheter in uremic patient can be stressful for the patient and the physician. Anxiety, agitation or encephalopathy can lead to interruption of procedure or surgical contamination.This trial evaluated the safety and efficacy of dexmedetomidine (Dex) for sedation during urgent placement of PD or HD catheters in uremic syndrome Methods: Prospective case-control clinical trial performed among patient (>18y) with ESRD, from july 2022 to january 2025 at Nephrology of the Hospital Civil de Guadalajara,a tertiary care center for uninsured people in western Mexico. Patients requiring emergency dialysis due to life-threatening symptoms, underwent catheter placement or replacement. The nephrologist decided whether to use DEX for sedation, based on the physician`s experience and drug availability. Demographic, clinical and paraclinical characteristics were recorded until 1 month after hospital discharge. Results: We included 221 patients,64% male,115 with DEX (Table 1-3). Doses: 0.3ug/kg(70%),aditional doses(20%).There was no significant difference in procedure duration,bradycardia occurred more frequently in the DEX group without hemodynamic repercussions.Hypertension and agitation were more common in control patients and was necessary to restrain the patient or interrupt the procedure. Conclusion: DEX sedation was associated with improved perioperative comfort and hemodynamic control compared to local anesthesia alone. Although associated with a higher incidence of bradycardia,DEX reduced hypertensive episodes and agitation/anxiety, supporting its safe and effective use in uremic patients.