Association between dexmedetomidine use and acute kidney injury in critically ill patients treated with amikacin

Amikacin is frequently used in intensive care units (ICUs) for gram-negative infections; however, nephrotoxicity remains a concern. Recent data showed lower odds of acute kidney injury (AKI) in patients who received dexmedetomidine, a selective α2-adrenergic receptor agonist widely used in ICUs for sedation and analgesia. Possible benefits of dexmedetomidine in critical patients who are treated with nephrotoxic therapies have not been studied. We aimed to test this hypothesis in a retrospective cohort study of adult ICU patients treated with amikacin between January 2018 and July 2020. Multivariable logistic regression analysis was performed to assess whether dexmedetomidine exposure was associated with AKI. A total of 149 patients were included. AKI occurred in 52 patients (34.9%), with a median onset of 5 days after amikacin initiation. AKI severity was stage 1 in 25.0%, stage 2 in 28.8%, and stage 3 in 46.2% of cases. Renal replacement therapy was required in 17 patients (11.6%). Dexmedetomidine was administered to 50 patients (33.6%) during amikacin therapy. In multivariable analysis, higher baseline serum creatinine and heart failure were independently associated with higher odds of AKI, whereas dexmedetomidine use was independently associated with lower odds of AKI. In a propensity score-matched analysis, AKI occurred less frequently in the dexmedetomidine group (17.4% vs. 37.0%, p = 0.035). Overall, ICU mortality was 67.8%, and AKI remained an independent predictor of mortality. Dexmedetomidine use was associated with lower odds of AKI in critically ill patients receiving amikacin. Prospective studies are warranted to confirm these findings.