Renoprotective Action of Fenoldopam in High-Risk Patients Undergoing Cardiac Surgery

Abstract

Background— Acute renal failure is a serious complication of cardiac surgery causing high morbidity and mortality. The aim of this study was to evaluate the usefulness of fenoldopam, a specific agonist of the dopamine-1 receptor, in patients at high risk of perioperative renal dysfunction. Methods and Results— A prospective single-center, randomized, double-blind trial was performed after local ethical committee approval and after written consent was obtained from 80 patients undergoing cardiac surgery. Patients received either fenoldopam at 0.05 μg/kg per minute or dopamine at 2.5 μg/kg per minute after the induction of anesthesia for a 24-hour period. All these patients were at high risk of perioperative renal dysfunction as indicated by Continuous Improvement in Cardiac Surgery Program score >10. Primary end point was defined as 25% creatinine increase from baseline levels after cardiac surgery. The 2 groups (fenoldopam versus dopamine) were homogeneous cohorts, and no difference in outcome was observed. Acute renal failure was similar: 17 of 40 (42.5%) in the fenoldopam group and 16 of 40 (40%) in the dopamine group ( P =0.9). Peak postoperative serum creatinine level, intensive care unit and hospital stay, and mortality were also similar in the 2 groups. Conclusions— Despite an increasing number of reports of renal protective properties from fenoldopam, we observed no difference in the clinical outcome compared with dopamine in a high-risk population undergoing cardiac surgery.

Acute Kidney Injury following Cardiac Surgery: Role of Perioperative Blood Pressure Control

“…The ideal perioperative antihypertensive agent would have rapid onset and short duration of activity with easy titration to effect and a low risk of overshoot hypotension [42]. The benefits and limitations of currently used agents are summarized in tables 3 and 4[29,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75]. Where available, comparison studies have been included; however, it should be noted that rigorous studies involving commonly used antihypertensives are few and far between and, with the exception of the ECLIPSE program, were completed more than a decade ago.…”

Prevention and Treatment of Acute Kidney Injury in Patients Undergoing Cardiac Surgery: A Systematic Review

“…1). A total of 70 studies (5,554 patients) met eligibility criteria [17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81,82,83,84,85,86] (table 1). …”

“…The incidence of acute renal replacement therapy was provided in 21 studies comprising 2,172 patients [18,25,27,28,32,33,34,40,45,52,55,56,60,61,67,69,71,75,77,81,82]. Predefined criteria for acute renal replacement therapy initiation were provided in 7 of these studies and were not uniform across studies [25,27,40,55,56,77,81].…”

“…Predefined criteria for acute renal replacement therapy initiation were provided in 7 of these studies and were not uniform across studies [25,27,40,55,56,77,81]. In 1 case, initiation was determined by blinded nephrologists without specific parameters described [81].…”

Acute Kidney Injury and Critical Cardiac Disease

“…87 Several reports suggest that fenoldopam infusions provide renal protection after CPB and during critical illness in adults. [88][89][90][91][92][93][94] The data available beyond case reports in the pediatric postoperative cardiac population are limited. In a retrospective cohort study by Costello et al, 95 the addition of fenoldopam to conventional diuretic therapy resulted in improved urine output, decreased inotrope score, and increased blood pressure in children refractory to standard diuretic treatment after cardiac surgery.…”