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

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 nonseptic 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.