Administration of fenoldopam in critically ill small animal patients with acute kidney injury: 28 dogs and 34 cats (2008–2012)

BackgroundAcute kidney injury (AKI) is common in dogs, but evidence of efficacy of its treatment is lacking.ObjectiveTo evaluate the efficacy of fenoldopam in the management of AKI.AnimalsForty dogs with naturally occurring heatstroke.MethodsDogs were prospectively enrolled and divided into treatment and the placebo groups (fenoldopam, constant rate infusion [CRI] of 0.1 µg/kg/min or saline, respectively). Urine production (UP) was measured using a closed system. Urinary clearances were performed at 4, 12, and 24 hours after presentation to estimate the effect of fenoldopam on UP, glomerular filtration rate (GFR) and sodium fractional excretion (NaFE).ResultsAt presentation, severity of heatstroke, based on a previously developed scoring system, was similar between the study groups, but was significantly worse in nonsurvivors compared with survivors. Fenoldopam administration was not associated with hypotension. Overt AKI was diagnosed, based on the International Renal Interest Society guidelines in 22/40 (55%) of the dogs. Overall, 14/40 dogs (35%) died, with no significant (P = .507) mortality rate difference between the fenoldopam (6/20 dogs; 30%) and placebo (8/20; 40%) groups. The proportion of dogs with AKI did not differ between the fenoldopam and the placebo groups (9/20; 45% versus 13/20; 65%, respectively; P = .204). There were no differences in UP, GFR, and NaFE between the fenoldopam and the placebo groups.Conclusion and Clinical ImportanceFenoldopam CRI at 0.1 µg/kg/min did not have a clinically relevant effect on kidney function parameters in dogs with severe heatstroke‐associated AKI.

Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Effects of fenoldopam on kidney function parameters and its therapeutic efficacy in the management of acute kidney injury in dogs with heatstroke

Segev

Bruchim

Berl

et al. 2018

“…The altered renal perfusion, tubular epithelial cell dysfunction, and altered tubular flow rate through the nephron observed in states of renal injury preclude simple extrapolation of the results of our study to a dog with AKI, because it cannot be assumed that a diseased kidney would respond similarly to fenoldopam. A recent retrospective study in dogs and cats with AKI indicated that fenoldopam administration resulted in no improvement in survival to discharge, duration of hospital stay, or renal biochemical variables when compared with AKI patients that did not receive the drug . The retrospective nature of this study failed to control for other concurrent treatments as well as the severity of AKI, and no objective measures of GFR or sodium excretion were performed.…”

Section: Discussionmentioning

confidence: 89%

“…A recent retrospective study in dogs and cats with AKI indicated that fenoldopam administration resulted in no improvement in survival to discharge, duration of hospital stay, or renal biochemical variables when compared with AKI patients that did not receive the drug. 24 The retrospective nature of this study failed to control for other concurrent treatments as well as the severity of AKI, and no objective measures of GFR or sodium excretion were performed. Prospective controlled clinical studies are warranted to assess the effect of fenoldopam on dogs with AKI.…”

Section: Discussionmentioning

confidence: 99%

Effect of Fenoldopam Continuous Infusion on Glomerular Filtration Rate and Fractional Excretion of Sodium in Healthy Dogs

Kelly

Drobatz

Foster

2016

BackgroundAcute kidney injury (AKI) is a common problem in small‐animal patients and carries a guarded prognosis with substantial morbidity and mortality, particularly in oligoanuric dogs. Fenoldopam, a selective dopamine agonist, has been shown to increase urine output in healthy dogs and cats; however, the mechanism of action is unknown.Hypothesis/ObjectivesTo evaluate the effect of fenoldopam infusion on glomerular filtration rate (GFR) and fractional excretion of sodium (FeNa) in healthy dogs.AnimalsTen healthy, privately owned dogs.MethodsRandomized, crossover design with negative control. Ten healthy dogs were given fenoldopam diluted in 5% dextrose (D5W) as a continuous IV infusion of 0.8 μg/kg/min for 5 hours and a control infusion of D5W alone, 7 days apart. Glomerular filtration rate was measured by exogenous iohexol clearance, beginning 1 hour after the start of the fenoldopam infusion. Fractional excretion of sodium (FeNa) was measured before and after the infusion. Glomerular filtration rate and change in FeNa were compared between treatment days.ResultsFenoldopam infusion resulted in a significantly increased (P = .0166) GFR (median GFR, 3.33 mL/min/kg) in healthy dogs compared with D5W infusion (median GFR, 2.71 mL/kg/min). Fenoldopam also resulted in a significantly increased (P = .0148) FeNa (mean change, 0.106), whereas infusion of D5W alone did not (mean change, 0.016).Conclusions and Clinical ImportanceIn healthy dogs, fenoldopam significantly increased GFR and FeNa compared with infusion of D5W alone. No adverse effects were seen.

“…The use of dopamine is controversial, and it no longer is used routinely in human patients . Recently, fenoldopam has been evaluated in human and veterinary patients with conflicting results …”

Section: Introductionmentioning

confidence: 99%

Sequential changes in urine production, glomerular filtration rate, and electrolyte excretion after mannitol administration

Segev

Stafford

Kirby

et al. 2019

Introduction Acute kidney injury (AKI) leading to severe uremia is associated with high morbidity and mortality. Mannitol is an osmotic diuretic, widely used in the management of AKI, both as a bolus injection and as a constant rate infusion (CRI). Objectives To determine the plasma concentration of mannitol after a bolus injection and CRI at the recommended dosages, and to assess the effect of mannitol on renal function variables including urine production, glomerular filtration rate (GFR), and solute excretion. Methods Prospective cross‐over design study, using 6 healthy dogs. Each dog underwent 3 protocols with at least a 7‐day washout period between protocols. The first protocol included bolus injection of mannitol, the second protocol included bolus injection followed by CRI of mannitol and the third protocol (control) included injection of 5% dextrose in water (D5W). Urine production, GFR, and fractional excretion (FE) of solutes were measured for 10 hours. Results For all protocols, urine production significantly ( P < .001) increased after bolus injection, but no significant difference in urine production or GFR was observed among the treatment groups. Mannitol injection increased the FE of sodium and urea nitrogen, but these effects were short ‐ lived. Conclusions Mannitol has minimal effect on urine production and GFR but does increase FE of urea nitrogen and sodium, immediately after bolus injection. Constant rate infusion at a conventional dosage of 1 mg/kg/min cannot maintain these effects in dogs with normal renal function, because mannitol concentration decreases rapidly.