Fenoldopam prophylaxis of postoperative acute renal failure in high-risk cardiac surgery patients.
BACKGROUND
Acute renal failure requiring replacement therapy occurs in 1% to 2% of patients who have undergone cardiac surgery with cardiopulmonary bypass and is associated with a very high mortality rate. The aim of this study was to determine if prophylactic treatment with fenoldopam mesylate of patients at high risk of postoperative acute renal failure reduced the incidence of this event.


METHODS
This was a multicenter, prospective, cohort study in which 108 patients at high risk of postoperative acute renal failure and undergoing cardiac surgery with cardiopulmonary bypass were treated with fenoldopam mesylate (0.08 microg x kg(-1) x min(-1)) starting at the induction of anesthesia and throughout at least the next 24 hours. A homogeneous control group of 108 patients was created using a propensity-score analysis.


RESULTS
Fenoldopam prophylaxis was significantly associated with a reduction in acute renal failure incidence (from 22% to 11%, p = 0.028), a less pronounced creatinine clearance decrease (p = 0.05), and a lower mortality rate (6.5% versus 15.7%, p = 0.03) by the univariate analysis, but these results were not confirmed by a multivariable analysis. Within the subgroup of patients who suffered a postoperative low output syndrome, fenoldopam prophylaxis was an independent protective factor for postoperative renal failure (odds ratio, 0.14; 95% confidence interval, 0.03 to 0.7; p = 0.017).


CONCLUSIONS
Given the limitations of a nonrandomized prospective trial, our results support the hypothesis that fenoldopam may reduce the risk of acute renal failure in patients in whom endogenous and exogenous cathecolamines action may induce a renal vascular constrictive condition.
Cardiothoracic Anesthesia and Intensive Care, Istituto Policlinico S. Donato, Milan, Italy.
Marco
M
Ranucci
Giorgio
G
Soro
Nicoletta
N
Barzaghi
Alessandro
A
Locatelli
Gianbeppe
G
Giordano
Angelo
A
Vavassori
Aldo
A
Manzato
Chiara
C
Melchiorri
Tiziana
T
Bove
Glauco
G
Juliano
Maria Francesca
MF
Uslenghi
D058186:Acute Kidney Injury / Q000209:etiology / Q000517:prevention & control*; D000368:Aged; D015415:Biomarkers; D006348:Cardiac Surgical Procedures; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D018491:Dopamine Agonists / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D018818:Fenoldopam / Q000008:administration & dosage / Q000627:therapeutic use*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D011446:Prospective Studies; D012306:Risk; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use*
D015415:Biomarkers; D018491:Dopamine Agonists; D014665:Vasodilator Agents; D003404:Creatinine; D018818:Fenoldopam