A case series of low-dose fenoldopam in seventy cardiac surgical patients at increased risk of renal dysfunction.
OBJECTIVE
To evaluate the usefulness of low-dose fenoldopam mesylate in patients at risk of developing renal dysfunction after cardiac surgery requiring cardiopulmonary bypass.


METHODS
A prospective, single-center, observational study.


METHODS
University teaching hospital.


METHODS
Seventy patients scheduled for elective cardiac surgery with one or more predefined risk factors for renal dysfunction.


METHODS
After induction of anesthesia, fenoldopam (0.03 microg/kg/min) was administered throughout surgery and into the postoperative period, until the patient was stable and weaned from all other vasoactive agents. Perioperatively, fenoldopam was also used as a second-line antihypertensive agent as required.


RESULTS
No patient developed renal failure that required dialysis, whereas 7.1% (5/70) developed non-dialysis-dependent renal dysfunction. Four out of these 5 patients had 2 or more risk factors (9.5%). Higher preoperative creatinine levels, a history of hypertension, myocardial infarction within 5 days of surgery, and a preoperative diagnosis of chronic renal insufficiency were all good predictors of postoperative non-dialysis-dependent renal dysfunction. Discharge serum creatinine levels were lower than preoperative levels (1.16 +/- 0.36 mg/dL v 1.26 +/- 0.34 mg/dL, p < 0.05).


CONCLUSIONS
These findings suggest that renal function was preserved in patients at increased risk for renal dysfunction after cardiac surgery when low-dose fenoldopam was used in the perioperative period. However, a randomized, controlled trial is required to establish efficacy.
Garwood
Susan
S
Department of Anesthesiology, Yale University School of Medicine, New Haven, CT 06520, USA. susan.garwood@yale.edu
Swamidoss
Cephas P
CP
Davis
Elizabeth A
EA
Samson
Leah
L
Hines
Roberta L
RL
D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood; D004305:Dose-Response Relationship, Drug; D005260:Female; D018818:Fenoldopam / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000517:prevention & control*; D012307:Risk Factors
D000959:Antihypertensive Agents; D003404:Creatinine; D018818:Fenoldopam