ONTRAST-INDUCED NEPHROPAthy, which occurs in 1% to 15% of all patients undergoing invasive angiographic procedures and in as many as 50% of patients with preexisting renal insufficiency or diabetes mellitus, is one of the most common causes of hospitalacquired acute renal failure. [1][2][3][4][5][6][7] The development of contrast-induced nephropathy after diagnostic coronary angiography and percutaneous intervention is associated with prolonged hospitalization, marked increases in morbidity and early and late mortality, and costs. [4][5][6][7][8] Other than hydration, 9,10 most prior studies of measures to prevent contrast-induced nephropathy have either been neutral, 11 found deleterious effects, [12][13][14][15] or in the case of N-acetylcysteine, reported conflicting results. [16][17][18][19]

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We evaluated the ability of fenoldopam, a newly available renal vasodilator, to prevent radiocontrast nephropathy in high-risk patients undergoing interventional diagnostic and therapeutic angiographic procedures. We reviewed the results from 46 consecutive procedures in patients with serum creatinine > or = 1.5 mg/dL if diabetic and > or = 1.7 mg/dL if nondiabetic. We compared our results to a previously published cohort of similarly at-risk patients. The incidence of radiocontrast nephropathy, defined as an increase in serum creatinine of > or = 25% at 48 hr following the procedure, was 13% in the group treated with fenoldopam, compared to an expected 38%. The percentage change in serum creatinine at 48 hr was +16% vs. +118%, respectively, in the two groups. In this preliminary experience, the use of fenoldopam in high-risk patients appears to minimize the likelihood of radioncontrast nephropathy. Cathet Cardiovasc Intervent 2001;53:341-345.

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