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Dexmedetomidine, a selective \u03b1\u2082-adrenergic agonist with anti-inflammatory properties, may protect the kidney during non-cardiac surgery. This study examined whether intraoperative dexmedetomidine reduces AKI in both high-risk and low-risk patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was a secondary analysis of a randomized double-blind placebo-controlled trial. Patients aged\u2009\u2265\u200960\u00a0years scheduled for elective non-cardiac surgery expected to last\u2009\u2265\u20092\u00a0h under general anesthesia were enrolled and classified as low-risk or high-risk using the General Surgery Acute Kidney Injury Risk Index. Participants were randomly allocated to receive intraoperative dexmedetomidine (loading dose 0.6\u00a0\u03bcg\/kg over 10\u00a0min before induction, followed by 0.5\u00a0\u03bcg\/kg\/h until 1\u00a0h before surgery end) or normal saline. The primary endpoint was AKI incidence within 7 postoperative days.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among high-risk patients, AKI occurred in 12.6% (13\/103) of the dexmedetomidine group versus 23.4% (25\/107) of controls (RR 0.54, 95% CI 0.29 to 1.00,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.043); after multivariable adjustment, dexmedetomidine remained independently associated with lower AKI risk (OR 0.44, 95% CI 0.20 to 0.98,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.045). In contrast, low-risk patients showed no significant difference with or without dexmedetomidine (7.9% vs 9.6%; RR 0.82, 95% CI 0.44 to 1.55,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.543; adjusted OR 0.65, 95% CI 0.30 to 1.38,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.260). Urological surgery was an independent predictor of AKI across the entire cohort.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Intraoperative dexmedetomidine was associated with lower risk of AKI in high-risk but not in low-risk patients undergoing non-cardiac surgery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00540-026-03661-8","type":"journal-article","created":{"date-parts":[[2026,1,17]],"date-time":"2026-01-17T13:25:23Z","timestamp":1768656323000},"page":"726-736","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Dexmedetomidine reduces acute kidney injury in high-risk but not low-risk patients after non-cardiac surgery: secondary analysis of a randomized controlled trial"],"prefix":"10.1007","volume":"40","author":[{"given":"Xin-Quan","family":"Liang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mei-Lin","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chun-Jing","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,1,17]]},"reference":[{"issue":"2","key":"3661_CR1","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1097\/ACO.0000000000001104","volume":"35","author":"B Ojo","year":"2022","unstructured":"Ojo B, Campbell CH. 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