A protocol for prevention of radiographic contrast nephropathy during percutaneous coronary intervention: effect of selective dopamine receptor agonist fenoldopam.
Radiographic contrast nephropathy (RCN), acute worsening of renal function due to contrast agents, can occur in 15%-40% of patients with baseline renal dysfunction undergoing percutaneous coronary intervention (PCI) and is associated with increased morbidity and in-hospital mortality. The purpose of this study was to evaluate whether the selective dopamine-1 (DA-1) receptor agonist fenoldopam would be beneficial in patients with chronic renal insufficiency (CRI) undergoing PCI and also to design a protocol for prevention of RCN. We analyzed 150 consecutive patients with CRI [baseline serum creatinine (BSCr) +/- 1.5% mg] who underwent PCI and received fenoldopam during and after the procedure, in addition to saline hydration. RCN, defined as > 25% increase of BSCr 48-72 hr after PCI, occurred in 4.7% (n = 7) of 150 PCI patients receiving fenoldopam and 3.5% in diabetics (n = 85) vs. 6.1% in nondiabetics (n = 65; P = NS). No patients required dialysis. The observed 4.7% incidence of RCN with fenoldopam was significantly lower than 18.8% incidence in the historical control group (P < 0.001). Our data suggest that fenoldopam is a useful adjunct in the prevention of RCN during PCI, especially in diabetics.
Kini
Annapoorna S
AS
Cardiac Catheterization Laboratory, Cardiovascular Institute, Mount Sinai School of Medicine, One Gustave Levy Place, New York, NY 10029, USA.
Mitre
Cristina A
CA
Kim
Michael
M
Kamran
Mazullah
M
Reich
David
D
Sharma
Samin K
SK
D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D003287:Contrast Media / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood; D018491:Dopamine Agonists / Q000627:therapeutic use*; D005260:Female; D018818:Fenoldopam / Q000627:therapeutic use*; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D015994:Incidence; D007674:Kidney Diseases / Q000139:chemically induced / Q000517:prevention & control*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D016896:Treatment Outcome
D000959:Antihypertensive Agents; D003287:Contrast Media; D018491:Dopamine Agonists; D003404:Creatinine; D018818:Fenoldopam