title: Dexmedetomidine Is Associated With Lower Incidence of Acute Kidney Injury After Congenital Heart Surgery.
abstract: OBJECTIVE
  Recent data have suggested an association between the use of dexmedetomidine and a decreased incidence of acute kidney injury in adult patients after cardiopulmonary bypass. However, no study has focused on this association among pediatric populations where the incidence of acute kidney injury is particularly high and of critical significance. The primary objective of this study was to assess the relationship between the use of postoperative dexmedetomidine and the incidence of acute kidney injury in pediatric patients undergoing cardiopulmonary bypass. The secondary objective was to determine whether there was an association between dexmedetomidine use and duration of mechanical ventilation or cardiovascular ICU stay.
  
  
  METHODS
  Single-center retrospective matched cohort study.
  
  
  METHODS
  A 20-bed quaternary cardiovascular ICU in a university-based pediatric hospital in California.
  
  
  METHODS
  Children less than 18 years old admitted after cardiac surgery with cardiopulmonary bypass between January 1, 2012, and May 31, 2014.
  
  
  METHODS
  None.
  
  
  RESULTS
  Data from a cohort of 102 patients receiving dexmedetomidine during the first postoperative day after cardiac surgery were compared to an age- and procedure-matched cohort not receiving dexmedetomidine. Cohorts had similar baseline and demographic characteristics. Patients receiving dexmedetomidine were less likely to develop acute kidney injury (24% vs 36%; odds ratio, 0.54; 95% CI, 0.29-0.99; p = 0.046). After adjusting for age, bypass time, nephrotoxin use, and vasoactive inotropic score, the use of dexmedetomidine was associated with a lower incidence of acute kidney injury with adjusted odds ratio of 0.43 (95% CI, 0.27-0.98; p = 0.048). There was no difference between the cohorts with respect to the duration of mechanical duration (1 d each; p = 0.98) or cardiovascular ICU stays (5 vs 6 d; p = 0.91).
  
  
  CONCLUSIONS
  The use of a dexmedetomidine infusion in pediatric patients after congenital heart surgery was associated with a decreased incidence of acute kidney injury; however, it was not associated with changes in clinical outcomes. Further prospective study is necessary to validate these findings.
authors.affiliation: 1Division of Cardiology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA. 2Division of Nephrology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA. 3Department of Pharmacy, Lucile Packard Children's Hospital Stanford, Palo Alto, CA.
authors.forename: David M
authors.initials: DM
authors.lastname: Kwiatkowski
authors.forename: David M
authors.initials: DM
authors.lastname: Axelrod
authors.forename: Scott M
authors.initials: SM
authors.lastname: Sutherland
authors.forename: Tiffany M
authors.initials: TM
authors.lastname: Tesoro
authors.forename: Catherine D
authors.initials: CD
authors.lastname: Krawczeski
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology / Q000517:prevention & control*; D058647:Adrenergic alpha-2 Receptor Agonists / Q000627:therapeutic use*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002675:Child, Preschool; D015331:Cohort Studies; D020927:Dexmedetomidine / Q000627:therapeutic use*; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery; D006801:Humans; D015994:Incidence; D007223:Infant; D015278:Intensive Care Units, Pediatric; D007902:Length of Stay; D008297:Male; D012121:Respiration, Artificial; D012189:Retrospective Studies
chemical_list: D058647:Adrenergic alpha-2 Receptor Agonists; D020927:Dexmedetomidine