Fenoldopam Mesylate for the Prevention of Contrast-Induced Nephropathy

Abstract

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]

Contrast‐induced nephropathy

“…The incidence of CIN was similar in the fenoldopam and control groups (15.7% vs. 15.3%, respectively; P ¼ NS) [78]. The second larger trial by Stone et al [79] confirmed the lack of benefit with fenoldopam. In this double-blind trial, a total of 315 patients (all treated with saline 0.45%) were randomized to fenoldopam (0.05 lg/kg/min titrated to 0.1 lg/ kg/min) or placebo starting 1 hr before the procedure and continuing for 12 hr afterward.…”

“…In this double-blind trial, a total of 315 patients (all treated with saline 0.45%) were randomized to fenoldopam (0.05 lg/kg/min titrated to 0.1 lg/ kg/min) or placebo starting 1 hr before the procedure and continuing for 12 hr afterward. There was no significant difference in the incidence of CIN within 96 hr in the 2 groups (33.6% vs. 30.1%, respectively; P ¼ NS), or rates of dialysis, rehospitalization, and death at 30 days [79].…”

“…In a double-blind, randomized, placebo-controlled pilot trial [77], the combination of fenoldopam and hydration, compared with hydration alone, resulted in an increase in renal plasma flow, a decrease in peak serum creatinine level 72 hr after exposure to contrast media, and a trend toward decreased incidence of CIN (21% and 41%, respectively; P ¼ 0.14). Two other prospective randomized trials showed negative results [78,79]. In the first trial, patients were randomized to saline infusion alone (control) or saline with fenoldopam (0.1 lg/kg/min for 4 hr before and after the procedure); a third arm was treated with acetylcysteine.…”

Prevenção de nefrotoxicidade por contraste com solução de bicarbonato: resultados preliminares e revisão da literatura

“…The comparison between fenoldopam and placebo regarding the relative risk for CN has favored fenoldopam, but with no statistical significance. [39][40] The lack of effect of the drug may be attributed to insufficient doses to cause renal vasodilation. The use of theophylline or aminophylline has been assessed in nine clinical trials, and the results were conflicting.…”

Oral Selenium: Can It Prevent Contrast-Induced Nephropathy Following Coronary Angiography and Angioplasty

“…Another preventive approach is the use of substances that can lessen such complications. N-acetyl cystein, sodium bicarbonate, Vitamin C, theophyline, fenoldopam, statins, and low dose dopamine and pentoxiphylline are examples of the substances used so far for this purpose, among which N-acetyl cystein has been more prominent (2,8,9).…”