Renoprotective action of fenoldopam in high-risk patients undergoing cardiac surgery : A prospective, double-blind, randomized clinical trial

• Published in: Circulation (New York, N.Y.) Vol. 111; no. 24; pp. 3230 - 3235
• Main Authors: BOVE, Tiziana, LANDONI, Giovanni, CALABRO, Maria Grazia, ALETTI, Giacomo, MARINO, Giovanni, CERCHIERINI, Elisa, CRESCENZI, Giuseppe, ZANGRILLO, Alberto
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 21.06.2005
• Subjects: Aged; Biological and medical sciences; Blood and lymphatic vessels; Cardiac Surgical Procedures - adverse effects; Cardiology. Vascular system; Cardiovascular system; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Dopamine - pharmacology; Dopamine - therapeutic use; Dopamine Agonists - pharmacology; Dopamine Agonists - therapeutic use; Double-Blind Method; Female; Fenoldopam - administration & dosage; Fenoldopam - pharmacology; Humans; Intraoperative Complications - prevention & control; Male; Medical sciences; Middle Aged; Perioperative Care; Pharmacology. Drug treatments; Protective Agents - therapeutic use; Renal Insufficiency - etiology; Renal Insufficiency - prevention & control; Risk; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Treatment Outcome; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels; Vasodilator agents. Cerebral vasodilators; Human; Agonist; Vasodilator agent; D1 Dopamine receptor; Cardiovascular disease; kidney failure, acute; Fenoldopam; anesthesia; Diuretic; Hypotensive drug; diuretics; Surgery; Dopamine agonist; Risk factor; cardiopulmonary bypass; Antihypertensive agent
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/CIRCULATIONAHA.104.509141

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. 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 microg/kg per minute or dopamine at 2.5 microg/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. 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.