Postoperative acute kidney injury (PO-AKI) is a significant complication, especially after complex surgeries. The choice of anesthetic may influence PO-AKI risk. While sevoflurane (SEVO) has been associated with potential renal risks, dexmedetomidine (DXM) has demonstrated renoprotective effects in various surgical settings. These protective effects may be linked to DXM's immunomodulatory properties and influence on the redox balance. Given the common use of SEVO in major non-cardiac surgery and the potential for renal vulnerability, particularly in the elderly, this study hypothesizes that perioperative DXM infusion in patients undergoing major non-cardiac surgery with SEVO anesthesia will reduce the incidence and severity of PO-AKI, especially in those with pre-existing or borderline renal dysfunction.

Inclusion Criteria:

• Patients who were assigned for TKR surgery;
• Patients with preoperative serum creatinine (SCr) levels of <1.1 mg/ml;
• Patients with controlled medical conditions;
• Patients free of exclusion criteria were enrolled in the study.

Exclusion Criteria:

• Male patients were excluded to guard against the impact of senile prostatic hypertrophy on kidney functions;
• Patients who had preoperative SCr of >1.1 mg/dl;
• Presence of any urological disorders, urological stone diseases;
• Patients with autoimmune diseases, medical disorders requiring maintenance on immunosuppressant therapy;
• Patients with cancer anywhere in the body were excluded.