Fenoldopam in Critically Ill Patients with Early Renal Dysfunction. A Crossover Study

Abstract

SUMMARYBackground: Acute kidney injury is a frequent problem among many critically ill patients, commonly in the context of multiple organ failure and decreased renal perfusion. Its presence conveys a poor prognosis. Currently, effective therapeutic interventions are limited and dopaminergic agonists have been suggested as an option to prevent further damage. Methods: We performed a randomized, double-blinded, prospective crossover study in 17 patients admitted to our trauma intensive care unit (ICU) with evidence of impaired renal function. Patients were randomized to a 24-h intravenous infusion of low-dose fenoldopam or placebo. When the infusion of fenoldopam or placebo was completed, patients underwent a 24-h "washout" period in which no study intervention was performed. This sequence was repeated in each patient with the opposite agent, so each patient served as his own control. Four-hour creatinine collections were taken during the last 4 h of each infusion and washout periods to determine creatinine clearance changes during and after the administration of the study drug. Results: The creatinine clearance was higher with fenoldopam infusion than with placebo infusion (P = 0.045). The FENa was not significantly different. Conclusions: Our study showed that low-dose Fenoldopam increases creatinine clearance in the critically ill with renal insufficiency. Fenoldopam may be a useful drug in ICU patients with early renal dysfunction.

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

“…In human medicine, fenoldopam is primarily used for management of hypertensive crises . It is also used to manage AKI in critically ill people . A meta‐analysis of 1,290 critically ill people found that fenoldopam consistently and significantly reduced the risk of AKI, need for renal replacement therapy, and in‐hospital death rate .…”

“…1,7 It is also used to manage AKI in critically ill people. [8][9][10][11][12] A meta-analysis of 1,290 critically ill people found that fenoldopam consistently and significantly reduced the risk of AKI, need for renal replacement therapy, and in-hospital death rate. 12 Fenoldopam had positive effects on urine output, GFR, natriuresis, and creatinine clearance in experimental studies using both ischemic and healthy dogs.…”

Fenoldopam Mesylate: A Narrative Review of Its Use in Acute Kidney Injury

“…Furthermore, the meta-analysis performed by Landoni et al [61] examined patients with or at risk of ARF, who were critically ill or underwent major surgery. The authors demonstrated that FM significantly reduced the risk for AKI, need for RRT, and in-hospital death.…”

Sepsis: An Example of Type 5 Cardiorenal Syndrome

“…Dati presenti in letteratura ci dicono che non sembra esserci un razionale per l'utilizzo della dopamina quale agente in grado di migliorare il quadro emodinamico a livello renale (49,50). Pochi studi hanno, invece, considerato l'utilizzo del fenoldopam (51,52). L'impiego di noradrenalina determina una riduzione della perfusione renale in condizioni fi siologiche ma dà luogo a un incremento della pressione sistemica nei pazienti settici (53), i quali si giovano anche dell'utilizzo della vasopressina che determina un incremento della diuresi e della frazione di fi l-…”