Preventing renal failure in critically ill patients

Aurora, R. Nisha; Milite, Fulvia; Carlon, Graziano C.

doi:10.1097/00003246-199909000-00065

Cited by 7 publications

(2 citation statements)

References 9 publications

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“…In conclusion, patients undergoing OLT may experience renal dysfunction as a result of a wide range of causes and mechanisms that may be interdependent and may vary in importance on an individual basis 12, 16–28, 32. The results of our study confirm that dopamine has no real renoprotective action in this setting, and that fenoldopam is capable of preserving creatinine clearance.…”

Section: Discussionmentioning

confidence: 53%

“…Nevertheless, the first (albeit limited) clinical experiences involving the use of fenoldopam as a means of preventing ARF were encouraging in patients undergoing coronary bypass grafting,23 or major abdominal24 or elective aortic surgery,25 and in patients at risk for radiocontrast nephropathy,26 although a subsequent study found that it offered no additional protection over intravenous saline when administered after cardiovascular interventions with radiocontrast dye 27…”

Section: Discussionmentioning

confidence: 99%

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Use of fenoldopam to control renal dysfunction early after liver transplantation

et al. 2004

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With the aim of assessing whether fenoldopam can help to preserve renal function after liver transplantation, we randomized 140 consecutive recipients with comparable preoperative renal function to receive fenoldopam 0.1 g/kg/ minute (group F, 46 patients), dopamine 3 g/kg/minute (group D, 48 patients), or placebo (group P, 46 patients) from the time of anesthesia induction to 96 hours postoperatively. There were no differences between the groups in intraoperative urinary output or furosemide administration (both P ‫؍‬ .1). Daily recordings made during the first 4 postoperative days revealed no significant differences in urinary output (P ‫؍‬ .1), serum creatinine (P ‫؍‬ .5), the incidence of renal insufficiency (P ‫؍‬ .7), the need for loop diuretics (P ‫؍‬ .9) or vasoactive drugs (P ‫؍‬ .8). In comparison with preoperative levels, creatinine clearance at the end of the study in the patients receiving fenoldopam remained substantially unchanged, whereas it decreased by 39 and 12.3%, respectively, in the subjects receiving placebo or dopamine (P < .001); blood cyclosporine A (CsA) levels were similar in the 3 groups (P ‫؍‬ .1). Three subjects died in the intensive care unit (1 in each group, P ‫؍‬ .9), 2 of them had renal failure. In conclusion, our results confirm the inefficacy of dopamine in preventing or limiting early renal dysfunction after liver transplantation, and suggest that fenoldopam may preserve creatinine clearance by counterbalancing the renal vasoconstrictive effect of CsA, as it has been reported in previous experimental studies. A cute renal failure (ARF) is defined as a sudden and marked reduction in the amount of renal glomerular filtrate, leading to an accumulation of nitrogen and other toxins that complicates the management of fluids and electrolytes; 1 it affects about 5% of hospitalized patients and approximately 15% of those who are critically ill, thus prolonging their length of hospitalization, increasing the related costs, and considerably affecting their outcomes. 2 Orthotopic liver transplantation (OLT) is burdened by an incidence of ARF that ranges from 10 to 25%, with a mortality rate that exceeds 50% when renal replacement therapy is required; 3 -5 in this setting, even moderate renal dysfunction is significantly associated with shortened graft and recipient survival. 6 As renal failure is a major risk factor capable of seriously compromising OLT outcomes, various strategies have been adopted in an attempt to prevent or at least limit its deleterious effects, but none have yet proved to be really efficacious. 7 -10 In order to refine the effects of dopamine on renal function, a number of analogs have been synthesized. One of these, fenoldopam, has attracted the attention of clinicians because of its ability to selectively vasodilate renal vessels, and has thus renewed interest in the possibility of combating the onset of perioperative ARF by means of intravenous drug infusion.The aim of this study was to evaluate the efficacy of fenoldopam as a "renoprotective" agent in the ear...

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Section: Discussionmentioning

confidence: 53%