Fenoldopam Reduces the Incidence of Renal Replacement Therapy After Cardiac Surgery

• Published in: Journal of cardiothoracic and vascular anesthesia Vol. 22; no. 1; pp. 23 - 26
• Main Authors: Roasio, Agostino, MD, Lobreglio, Rosetta, MD, Santin, Agostino, MD, Landoni, Giovanni, MD, Verdecchia, Claudio, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2008
• Subjects: Acute Kidney Injury - drug therapy; acute renal failure; acute renal injury; Aged; Anesthesia & Perioperative Care; cardiac surgery; Cardiac Surgical Procedures - adverse effects; Case-Control Studies; Creatinine - blood; Critical Care; Dopamine Agonists - administration & dosage; Female; fenoldopam; Fenoldopam - administration & dosage; Humans; Incidence; kidney; Length of Stay; Male; Middle Aged; Monitoring, Intraoperative; renal replacement therapy; Renal Replacement Therapy - methods; Renal Replacement Therapy - utilization; Risk Factors; Time Factors; Treatment Outcome; acute renal injury; kidney; cardiac surgery; renal replacement therapy; acute renal failure; fenoldopam
• ISSN: 1053-0770; 1532-8422
• DOI: 10.1053/j.jvca.2007.07.012

Objective: To investigate whether a continuous 48-hour infusion of fenoldopam, 0.1 μg/kg/min, reduced the need for renal replacement therapy in patients with acute renal injury after cardiac surgery. Design: Case-matched study. Setting: Teaching hospital. Participants: Ninety-two patients. Interventions: Patients who developed acute renal injury (defined as serum creatinine doubling or oliguria) after cardiac surgery received a continuous infusion of fenoldopam, 0.1 μg/kg/min, (46 patients) for 48 hours. They were case matched with 46 patients who developed acute renal injury, had similar baseline characteristics, and received standard treatment (hemodynamic support to obtain a mean arterial pressure >60 mmHg, fluid administration to increase central venous pressure >10 mmHg, and loop diuretics to maintain a urine output >0.5 mL/kg/h). Renal replacement therapy was started when acute renal injury became oligoanuric, when serum creatinine increased >4 mg/dL or 3 times basal value, or in the presence of severe hyperkalemia (K >6.5 mmol/L) or severe acidemia (pH < 7). Measurements and Main Results: Patients in the fenoldopam group had a reduced need for renal replacement therapy (8 patients, 17%) with respect to case-matched controls (18 patients, 39%; p = 0.037). The length of intensive care unit stay (median [interquartile range]) was similar in the 2 groups: fenoldopam group, 5 days (3-9 days), and control group, 10 days (3-16 days, p = 0.15). Conclusions: Given the limitations of case-matched studies, fenoldopam may be useful in avoiding renal replacement therapy in patients who develop acute renal injury after cardiac surgery.