The Effect of Dexmedetomidine on the Renal Functions in Septic Critically Ill Patients

Recently, it has been confirmed that dexmedetomidine has an organ protective effect, including the nervous system, heart, lungs, kidneys, liver, and small intestine. These properties allow dexmedetomidine to be a promising candidate for clinical multiorgan protection.

Aim of the study: Evaluation of the effect of dexmedetomidine in Sepsis-Associated Acute Kidney Injury (SA-AKI).

Objectives:

1. Assessment of dexmedetomidine effect in SA-AKI through following serum creatinine (SCr) level, urinary output (UOP), and the need for renal replacement therapy (RRT). 2. Assessment of dexmedetomidine safety in SA-AKI through following the incidence of new-onset bradycardia, and hypotension requiring intervention. 3. Assessment of dexmedetomidine efficacy by determining the effect on hospital mortality, duration of mechanical ventilation (MV), days free of agitation, incidence of organ dysfunction other than AKI, and length of hospital and ICU stay.

Study Design:

The study will be a prospective, randomized, parallel, controlled, open-label clinical trial including 128 participants with SA-AKI. Participants will be recruited from the Critical Care Department at Cairo University Hospitals. Randomization will be carried out using Random Allocation Software. Patients will be randomly allocated into two groups after screening for inclusion and exclusion criteria.

Written informed consent will be obtained from participants' legal caregivers.

Ethical committee approval will be available.

The primary investigator will be responsible for data collection. Each participant will be presented using a sequential number.

Participants recruitment and concealment allocation, data collection, data management, and data analysis will all be subjected to supervision and on-site auditing by academic and medical supervisors. For data verification, medical records revision will be done, to ensure the accuracy and completeness of the collected data.

Based on the pattern and percentage of missing data, the study investigator is expecting either missing completely at random (MCAR) or missing at random (MAR). Accordingly, multiple imputation (MI) will be implemented to handle missing data.

Normal ranges for lab data will be available.

Study outcomes will be assessed every 48 hours.

Sample size calculation:

Sample size calculation was performed using G power software. The sample size was based on an effect size of 0.5272. A total sample size of 116 patients (58 patients per group) is needed to reject the null hypothesis of equality of means between the control and treatment groups with an 80% power at a 5% significance level (α = 0.05) using two tails t-test.

The effect size was calculated based on the difference in SCr between day 1 and day 3 in septic AKI patients (126.3µmol/L ± 27.6 in day 1 vs. 132.3 µmol/L ± 26.4 in day 3 in the control group vs. 113.2 µmol/L ± 28.9 in day 1 vs. 104.3 µmol/L ± 22.1 in day 3 in the dexmedetomidine group).

Including a dropout ratio of 10%, the final total sample size is 128 patients (64 patients per group).

Statistical analysis:

The collected data will be thoroughly revised, coded, and tabulated, followed by statistical analysis. Qualitative data will be presented as numbers and percentages. Quantitative data will be represented as mean and standard deviation (SD), or median and interquartile range (IQR) according to data distribution. Chi-square test will be used to compare groups regarding non-numerical variables. Independent samples t-test of significance will be used to compare two means.

To compare proportions between two qualitative characteristics, the Chi-square (x2) test of significance will be used.

A P-value of less than 0.05 will be considered statistically significant in all analyses.

• Incidence of Renal Replacement therapy (RRT) [Срок оценки: Assessment will be done at time of randomization then every 48 hours through hospitalization stay, an average of 2 weeks]
• Change in Sequential Organ Failure Assessment (SOFA). [Срок оценки: Assessment will be done at time of randomization then every 48 hours through hospitalization stay, an average of 2 weeks]
• Incidence of agitation [Срок оценки: Assessment will be done at time of randomization then every 48 hours through hospitalization stay, an average of 2 weeks]
• Incidence of bradycardia [Срок оценки: Assessment will be done at time of randomization then every 48 hours through hospitalization stay, an average of 2 weeks]
• Incidence of hypotension [Срок оценки: Assessment will be done at time of randomization then every 48 hours through hospitalization stay, an average of 2 weeks]
• Duration on mechanical ventilation [Срок оценки: Assessment will be done at time of randomization then every 48 hours through hospitalization stay, an average of 2 weeks]
• Length of hospital and ICU stay [Срок оценки: Assessment will be done at time of randomization then every 48 hours through hospitalization stay, an average of 2 weeks]
• Incidence of another organ dysfunction [Срок оценки: Assessment will be done at time of randomization then every 48 hours through hospitalization stay, an average of 2 weeks]
• In-hospital mortality [Срок оценки: From time of enrolment until date of death, assessed up to 1 month]