Effects of Dexmedetomidine on Microcirculation of Kidney Transplant Recipient
Condition: Kidney Disease
MeSH terms: Kidney Diseases
Study type: Interventional
Phase: Phase 4

Summary: 
      The microcirculation is altered in acute kidney injury and chronic kidney disease. The
      microcirculation is poor in end-stage renal disease patients receiving hemodialysis. Kidney
      transplant can improve the life quality of these patients. However, surgical stress and
      inflammatory response may cause microcirculatory dysfunction and intestinal injury. Moreover,
      the transplanted kidney would suffer from the ischemia and reperfusion injury, and it may
      result in acute kidney injury. In ischemia and reperfusion injury animal model,
      dexmedetomidine has been proven to attenuate kidney and intestinal injury. In our previous
      study of surgical stress and pain stimulation rat model, we found that dexmedetomidine
      attenuate the intestinal microcirculatory dysfunction. In patients receiving coronary artery
      bypass graft surgery, dexmedetomidine increases urine output and decreases postoperative
      serum level of neutrophil gelatinase-associated lipocalin.

      This study aims to investigate whether perioperative dexmedetomidine infusion may attenuate
      microcirculatory dysfunction, kidney injury, and intestinal injury for patients undergoing
      kidney transplant.
    

Detailed description: 
      The microcirculation is altered in acute kidney injury and chronic kidney disease. The
      microcirculation is poor in end-stage renal disease patients receiving hemodialysis. Kidney
      transplant can improve the life quality of these patients. However, surgical stress and
      inflammatory response may cause microcirculatory dysfunction and intestinal injury. Moreover,
      the transplanted kidney would suffer from the ischemia and reperfusion injury, and it may
      result in acute kidney injury. In ischemia and reperfusion injury animal model,
      dexmedetomidine has been proven to attenuate kidney and intestinal injury. In our previous
      study of surgical stress and pain stimulation rat model, we found that dexmedetomidine
      attenuate the intestinal microcirculatory dysfunction. In patients receiving coronary artery
      bypass graft surgery, dexmedetomidine increases urine output and decreases postoperative
      serum level of neutrophil gelatinase-associated lipocalin. The aim of this study is to
      investigate whether perioperative dexmedetomidine infusion may attenuate microcirculatory
      dysfunction, kidney injury, and intestinal injury for patients undergoing kidney transplant.

      This is a randomized, single-blind, prospective, controlled clinical trial. The patients will
      be randomly assigned to the control group or dexmedetomidine group. After induction of
      anesthesia, the patients in the control group will receive regular perioperative care. The
      patients in the dexmedetomidine group will receive perioperative dexmedetomidine continuous
      intravenous infusion after induction of anesthesia till 2 hours after the end of the
      operation. All patients will receive sublingual microcirculation examination, laboratory
      tests of blood urine nitrogen, creatinine, and enzyme-linked immunosorbent assays of serum
      level of endocan, diamine oxidase, and neutrophil gelatinase-associated lipocalin at preset
      time points. The urine level of neutrophil gelatinase-associated lipocalin will also be
      measured. The vital signs and urine output will be recorded. The difference between the two
      groups will be compared.
    

Intervention name(s): Dexmedetomidine
Intervention type(s): Drug
Intervention description(s): Dexmedetomidine infusion
Other intervention name(s): Precedex
Intervention MeSH terms: Dexmedetomidine
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Basic Science