The effects of fenoldopam, a selective dopamine receptor agonist, on systemic and renal hemodynamics in normotensive subjects

Mathur, Vandana; Swan, Suzanne K.; Lambrecht, Lawrence J.; Anjum, Shakeel; Fellmann, J. D.; McGuire, Dawn; Epstein, Murray; Luther, Robert R.

doi:10.1097/00003246-199909000-00021

Cited by 168 publications

(118 citation statements)

References 33 publications

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“…Although interest in the use of dopamine for renoprotection has decreased, interest in the use of another dopaminergic agent, fenol dopam, which exerts the same renal eff ects as dopamine [24], is, strangely enough, increasing. Fenoldopam is a selective dopamine-1 receptor agonist with no β-1 or α-adrenergic receptor agonistic eff ects and similar to dopamine, it increases renal plasma fl ow with no eff ects on GFR, as demonstrated in healthy volunteers [25]. In three pre ventive, randomized controlled trials in abdomi nal aortic surgery [26] and high-risk cardiac surgery [27], fenoldopam improved creatinine clearance compared to placebo.…”

Section: Eff Ects Of Dopaminergic Agents On Renal Oxygenation In the mentioning

confidence: 99%

Renal Oxygenation in Clinical Acute Kidney Injury

Ricksten¹,

Bragadottir²,

Redfors³

2013

Annual Update in Intensive Care and Emergency Medicine 2013

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Renal oxygenation is defi ned as the relationship between renal oxygen delivery (DO 2 ) and renal oxygen consumption (VO 2 ) and it can easily be shown that the inverse of this relationship is equivalent to renal extraction of O 2 (O 2 Ex). An increase in renal O 2 Ex means that renal DO 2 has decreased in relation to renal VO 2 , i. e., renal oxygenation is impaired, and vice versa. When compared to other major organs, renal VO 2 is relatively high, second only to the heart. In sedated, mechanically ventilated patients, renal VO 2 is two-thirds (10 ml/min) that of myocardial oxygen consumption (15 ml/min) (Table 1) [1,2]. Renal blo od fl ow, w hich accounts for approximately 20 % of cardiac output, is three times higher than myocardial blood fl ow in this group of patients. Renal O 2 Ex in the non-failing kidney is therefore low, 10 %, compared with, e.g., the heart, in which O 2 E X is 55 % (Table 1). Determin a nts of renal oxygenationIt is well known from experimental studies that tubular sodium reabsorption is the major determinant of renal VO 2 [3] and tha t under normal physiological conditions, approximately 80 % is used to drive active tubular transport of particularly sodium, but also glucose, amino acids and other solutes. Tubular transport processes are highly load-dependent and it has been shown in experimental studies [4] and in p atients [2,[5][6][7] that the re i s a close linear correlation between glomerular fi ltration rate (GFR), renal sodium reabsorption and renal VO 2 (Fig. 1). Th e fi l tered load of sodium is, thus, an important determi nant of renal VO 2 and maneuvers that decrease GFR and the tubular sodium load act to decrease tubular sodium reabsorption and renal VO 2 , and vice versa [8]. It has b een shown that renal O 2 Ex remains stable over a wide range of renal blood fl ows, which means that changes in renal DO 2 , caused by changes in renal blood fl ow, are directly off set by changes in renal VO 2 [9], i. e., r enal VO 2 is fl ow-dependent. Th us, unlike other organs where increases in blood fl ow will improve oxygenation, increased renal blood fl ow augments GFR and the fi ltered load of sodium, which will increase renal VO 2 . Due to this fl ow-dependency of renal VO 2 , renal oxygenation will re main constant, as long as renal blood fl ow and GFR change in parallel. Regional intrarenal oxygenation and medullary hypoxiaTh e relatively high renal blood fl ow is directed preferentially to the cortex to optimize the fi ltration process and solute reabsorption. In contrast, blood fl ow in the outer medulla is less than 50 % of the cortical blood fl ow to preserve osmotic gradients and to enhance urinary concentration [10]. Th e combi nation of low me dullary perfusion, high oxygen consumption of the medullary thick ascending limbs (mTAL) and the countercurrent exchange of oxygen within the vasa recta, results in a poorly oxygenated outer medulla [11]. Oxygen av ailability is, therefore, low in the outer medulla, which has an oxygen tissue partial pressure (PO 2 ) of 10-20 mm Hg ...

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Section: Eff Ects Of Dopaminergic Agents On Renal Oxygenation In the mentioning

confidence: 99%

Renal Oxygenation in Clinical Acute Kidney Injury

Ricksten¹,

Bragadottir²,

Redfors³

2013

Annual Update in Intensive Care and Emergency Medicine 2013

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“…9,17,18 Fenoldopam has been shown to increase renal plasma flow in patients with and without chronic renal insufficiency, 19,20 but there are at present no data from prospective clinical trials to support a reduction in the incidence of ARF. Despite the virtual absence of definitive evidence, the use of fenoldopam as a renal protective agent has become nearly standard practice in clinical situations that lead to impaired renal function, such as radiocontrast medium administration, shock, and cardiac or vascular surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Beneficial renal effects have been demonstrated at infusion rates as low as 0.03 g/kg per minute, 19 and other authors have studied even lower doses in cardiac surgery. 27 It is unlikely that a different dose or infusion duration of fenoldopam would prove effective.…”

Section: Study Limitationsmentioning

confidence: 99%

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

et al. 2005

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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.

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“…[14] In addition, there may exist a dose-response effect to the renoprotection of fenoldopam. [16] This study reviews the outcome of 100 consecutive ICU patients at risk of developing ARF who were treated with fenoldopam for renal protection. In comparison to patients who received low-dose fenoldopam, patients in the high-dose group experienced a significant decline in serum creatinine from baseline levels at 72 h. This decline occurred despite the fact that these patients had a higher (albeit not significantly) starting creatinine value than the low-dose group, suggesting that, on average, they had a smaller functioning nephron mass at the time the infusion was started.…”

Section: Discussionmentioning

confidence: 99%

“…[12 -15] Furthermore, any salutary effects of fenoldopam on renal function may be dose dependent. [16] The critical care unit at The University of Texas M. D. Anderson Cancer Center has administered fenoldopam to high-risk cancer patients to prevent ARF since 1999. In this paper, we report our experience with the first 100 patients who received fenoldopam for this indication.…”

Section: Introductionmentioning

confidence: 99%

Effect of Fenoldopam Mesylate in Critically Ill Patients at Risk for Acute Renal Failure is Dose Dependent

Samuels¹,

Finkel

Gubert

et al. 2005

Renal Failure

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Background: Acute renal failure (ARF) is common and difficult to prevent, especially in intensive care unit (ICU) patients with cancer. Therapeutic trials with various agents have generally been ineffective in preventing ARF. We describe the effects of two different doses of the dopamine DA-1 receptor agonist fenoldopam mesylate on renal function in a series of critically ill cancer patients at risk of developing ARF. Methods: We performed a retrospective chart review of 100 consecutive patients who received fenoldopam mesylate for at least 72 h in the medical and surgical ICUs of The University of Texas M. D. Anderson Cancer Center who were at risk of developing ARF. Eighteen patients received low-dose fenoldopam mesylate ( 0.05 mg/kg/min). The remaining 82 patients received high-dose fenoldopam mesylate (0.07 -0.1 mg/kg/min). Data were collected relating to drug dosage, patient demographics, severity of illness, and indices of renal function. Results: Patients were moderately ill, with a mean APACHE II score of 18 ± 6 at initiation of fenoldopam infusion. Eighty-five percent of patients had at least two risk factors for the development of ARF, and 20% had four. For the group overall, the incidence of ARF was 13%, and the hospital mortality rate was 37%. When compared with the low-dose group, patients who received highdose fenoldopam had a significantly shorter ICU length of stay despite a significantly higher APACHE II score ( p = 0.01). The high-dose group also had a highly significant decrease in serum creatinine levels at 72 h ( p = 0.005). Conclusions: These data support the hypothesis that fenoldopam mesylate may provide a degree of dose-dependent renal protection in cancer patients with early acute renal failure.

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The effects of fenoldopam, a selective dopamine receptor agonist, on systemic and renal hemodynamics in normotensive subjects

Cited by 168 publications

References 33 publications

Renal Oxygenation in Clinical Acute Kidney Injury

Renal Oxygenation in Clinical Acute Kidney Injury

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

Effect of Fenoldopam Mesylate in Critically Ill Patients at Risk for Acute Renal Failure is Dose Dependent

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