Use of fenoldopam to prevent radiocontrast nephropathy in high‐risk patients

Madyoon, Hooman; Croushore, Linda; Weaver, Douglas; Mathur, Vandana

doi:10.1002/ccd.1178

Cited by 91 publications

(68 citation statements)

References 24 publications

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“…25 The benefit of fenoldopam for the prevention of contrast-medium nephropathy has been demonstrated in a dog model and in nonrandomized clinical studies. 25,[59][60][61] In a small double-blind, randomized controlled pilot trial, fenoldopam plus normal saline was found to attenuate reductions in renal blood flow induced by contrast media; it was also associated with a lower incidence of contrast-medium nephropathy than was normal saline alone, although the difference between the 2 groups was not significant. 62 The benefit of fenoldopam was not validated in a large multicentre randomized placebo-controlled double-blind trial.…”

Section: Vasodilatorsmentioning

confidence: 99%

Nephropathy induced by contrast media: pathogenesis, risk factors and preventive strategies

Goldenberg

Matetzky²

2005

Canadian Medical Association Journal

322

300

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WITH THE INCREASING USE OF CONTRAST MEDIA in diagnostic and interventional procedures, nephropathy induced by contrast media has become the third leading cause of hospital-acquired acute renal failure. It is also associated with a significant risk of morbidity and death. The current understanding of the pathogenesis indicates that contrast-medium nephropathy is caused by a combination of renal ischemia and direct toxic effects on renal tubular cells. Patients with pre-existing renal insufficiency, diabetes mellitus and congestive heart failure are at highest risk. Risk factors also include the type and amount of contrast medium administered. Therapeutic prevention strategies are being extensively investigated, but there is still no definitive answer. In this article, we review the current evidence on the causes, pathogenesis and clinical course of contrast-medium nephropathy as well as therapeutic approaches to its prevention evaluated in clinical trials.

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Section: Vasodilatorsmentioning

confidence: 99%

Nephropathy induced by contrast media: pathogenesis, risk factors and preventive strategies

Goldenberg

Matetzky²

2005

Canadian Medical Association Journal

322

300

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“…Observational studies reported rather low rates of CIN in high-risk patients treated with fenoldopam [17,75,76]. 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).…”

Section: Fenoldopammentioning

confidence: 99%

Contrast‐induced nephropathy

Pučelíková

Dangas

Mehran

2007

Cathet Cardio Intervent

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Contrast induced nephropathy (CIN) is an iatrogenic disorder, resulting from exposure to contrast media. Contrast-induced hemodynamic and direct cytotoxic effects on renal structures are highly evident in its pathogenesis, whereas other mechanisms are still poorly understood. CIN is typically defined as an increase in serum creatinine by either 0.5 mg/dl or by 25% from baseline within the first 2-3 days after contrast administration. Although rare in the general population, CIN has a high incidence in patients with an underlying renal disorder, in diabetics, and the elderly. The risk factors are synergistic in their ability to produce CIN. The best way to prevent CIN is to identify the patients at risk and to provide adequate peri-procedural hydration. The role of various drugs in prevention of CIN is still controversial and warrants future studies. Despite remaining uncertainty regarding the degree of nephrotoxicity produced by various contrast agents, in current practice non-ionic low-osmolar contrast media are preferred over the high-osmolar contrast media in patients with renal impairment.

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“…There are several data assuming the direct tubular toxicity of the contrast media as a pathophysiological mechanism for the development of CIN. 6,15 Contrast media can also damage renal tubular cells via oxygen radicals. 16 Several clinical and experimental studies documented a significant correlation between proteinuria and progression of renal failure.…”

Section: 12mentioning

confidence: 99%

An Uninvestigated Risk Factor for Contrast-Induced Nephropathy in Chronic Kidney Disease: Proteinuria

et al. 2012

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Background: Contrast-induced nephropathy (CIN) is one of the most frequent causes of acute renal failure in hospitalized patients with the incremental use of contrast media. We aimed to investigate whether proteinuria may act as a risk factor for CIN in patients with chronic kidney disease. Methods: Seventy hospitalized patients (37 men, 33 women) with chronic kidney disease, proteinuria, and/or estimated glomerular filtration rate (eGFR) of <60 mL/min/1.73 m 2 , who were exposed to contrast media were investigated prospectively. Thirty patients were diabetic. All patients received prophylaxis against CIN with acetylcysteine and 0.9% intravenous saline. CIN is defined as either a 25% higher increase in serum creatinine (sCr) from the baseline levels or a 0.5 mg/dL increase in sCr at 72 h after contrast media exposure. Results: CIN was detected in 26 (37.1%) patients. Advanced age, diabetes, heart failure, anemia, baseline sCr of >1.5 mg/dL, baseline eGFR of <60 mL/min/1.73 m 2 , proteinuria of !1 g/day, hypoalbuminemia, and the volume of contrast media of !100 mL correlated significantly with CIN. The frequency of CIN was significantly higher in patients with proteinuria of !1 g/day compared to patients with proteinuria of <1 g/day (p ¼ 0.009). Conclusion: Proteinuria may be a new risk factor for the development of CIN in patients with chronic kidney disease.

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Use of fenoldopam to prevent radiocontrast nephropathy in high‐risk patients

Cited by 91 publications

References 24 publications

Nephropathy induced by contrast media: pathogenesis, risk factors and preventive strategies

Nephropathy induced by contrast media: pathogenesis, risk factors and preventive strategies

Contrast‐induced nephropathy

An Uninvestigated Risk Factor for Contrast-Induced Nephropathy in Chronic Kidney Disease: Proteinuria

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