Fenoldopam and Acute Renal Failure in Cardiac Surgery: A Meta-Analysis of Randomized Placebo-Controlled Trials

Zangrillo, Alberto; Biondi‐Zoccai, Giuseppe; Frati, Elena; Covello, Remo Daniel; Cabrini, Luca; Guarracino, Fabio; Ruggeri, Laura; Bove, Tiziana; Bignami, Elena; Landoni, Giovanni

doi:10.1053/j.jvca.2012.01.038

Cited by 77 publications

(34 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Fenoldopam, a selective DA 1 agonist, has showed some promise in small studies (not all of them randomized) (199)(200)(201)(202), although this has not been universal (203). The available meta-analytic data suggest a renoprotective effect in patients undergoing cardiac surgery, but larger well designed trials are needed (204).…”

Section: Current and Future Pharmacologic Strategiesmentioning

confidence: 99%

AKI Associated with Cardiac Surgery

Thiele¹,

Isbell²,

Rosner

2015

Clinical Journal of the American Society of Nephrology

261

198

View full text Add to dashboard Cite

Approximately 18% of patients undergoing cardiac surgery experience AKI (on the basis of modern standardized definitions of AKI), and approximately 2%-6% will require hemodialysis. The development of AKI after cardiac surgery portends poor short-and long-term prognoses, with those developing RIFLE failure or AKI Network stage III having an almost 2-fold increase in the risk of death. AKI is caused by a variety of factors, including nephrotoxins, hypoxia, mechanical trauma, inflammation, cardiopulmonary bypass, and hemodynamic instability, and it may be affected by the clinician's choice of fluids and vasoactive agents as well as the transfusion strategy used. The risk of AKI may be ameliorated by avoidance of nephrotoxins, achievement of adequate glucose control preoperatively, and use of goal-directed therapy hemodynamic strategies. Remote ischemic preconditioning is an exciting future strategy, but more work is needed before widespread implementation. Unfortunately, there are no pharmacologic agents known to reduce the risk of AKI or treat established AKI.

show abstract

Section: Current and Future Pharmacologic Strategiesmentioning

confidence: 99%

AKI Associated with Cardiac Surgery

Thiele¹,

Isbell²,

Rosner

2015

Clinical Journal of the American Society of Nephrology

261

198

View full text Add to dashboard Cite

show abstract

“…The benefit of fenoldopam in terms of AKI occurrence is difficult to evaluate due to heterogenous delays in administration and diagnosis criteria among studies. Four meta-analyses are available but show conflicting results: two of them reported a beneficial effect with a reduction in the risk of AKI, one did not find any beneficial effect and the last one did not analyse the risk of AKI [181][182][183][184]. Considering current data in the literature, it is recommended not to use fenoldopam for the prevention or treatment of AKI.…”

Section: Rationalementioning

confidence: 99%

Acute kidney injury in the perioperative period and in intensive care units (excluding renal replacement therapies)

Ichai

Vinsonneau

Souweine

et al. 2016

Anaesthesia Critical Care & Pain Medicine

View full text Add to dashboard Cite

Acute kidney injury (AKI) is a syndrome that has progressed a great deal over the last 20 years. The decrease in urine output and the increase in classical renal biomarkers, such as blood urea nitrogen and serum creatinine, have largely been used as surrogate markers for decreased glomerular filtration rate (GFR), which defines AKI. However, using such markers of GFR as criteria for diagnosing AKI has several limits including the difficult diagnosis of non-organic AKI, also called "functional renal insufficiency" or "pre-renal insufficiency". This situation is characterized by an oliguria and an increase in creatininemia as a consequence of a reduction in renal blood flow related to systemic haemodynamic abnormalities. In this situation, "renal insufficiency" seems rather inappropriate as kidney function is not impaired. On the contrary, the kidney delivers an appropriate response aiming to recover optimal systemic physiological haemodynamic conditions. Considering the kidney as insufficient is erroneous because this suggests that it does not work correctly, whereas the opposite is occurring, because the kidney is healthy even in a threatening situation. With current definitions of AKI, normalization of volaemia is needed before defining AKI in order to avoid this pitfall.

show abstract

“…Many drugs have been investigated to date to control the serum level of creatinine and renal protection. Fenoldopam, a selective agonist of dopamine-1 receptor, is the only drug that consistently and significantly has reduced the risk of AKI, followed by nesiritide with initial promising results [1,164,165] . Sodium bicarbonate was found in a known pilot study in 2009 to decrease the risk of AKI by 20% [166] .…”

Section: Pharmacological Interventionsmentioning

confidence: 99%

Serum creatinine role in predicting outcome after cardiac surgery beyond acute kidney injury

Najafi

2014

WJC

View full text Add to dashboard Cite

Serum creatinine is still the most important determinant in the assessment of perioperative renal function and in the prediction of adverse outcome in cardiac surgery. Many biomarkers have been studied to date; still, there is no surrogate for serum creatinine measurement in clinical practice because it is feasible and inexpensive. High levels of serum creatinine and its equivalents have been the most important preoperative risk factor for postoperative renal injury. Moreover, creatinine is the mainstay in predicting risk models and risk factor reduction has enhanced its importance in outcome prediction. The future perspective is the development of new definitions and novel tools for the early diagnosis of acute kidney injury largely based on serum creatinine and a panel of novel biomarkers.

show abstract

Fenoldopam and Acute Renal Failure in Cardiac Surgery: A Meta-Analysis of Randomized Placebo-Controlled Trials

Cited by 77 publications

References 33 publications

AKI Associated with Cardiac Surgery

AKI Associated with Cardiac Surgery

Acute kidney injury in the perioperative period and in intensive care units (excluding renal replacement therapies)

Serum creatinine role in predicting outcome after cardiac surgery beyond acute kidney injury

Contact Info

Product

Resources

About