Fenoldopam mesylate and renal function in patients undergoing liver transplantation: a randomized, controlled pilot trial.
To test the relative effects on serum creatinine (CRE), blood urea nitrogen (BUN), and urine output of small-dose dopamine and fenoldopam in patients undergoing liver transplantation, we randomized 43 patients to 1 of 2 continuous infusions over 48 h, starting with anesthesia induction: fenoldopam, 0.1 microg . kg(-1) . min(-1) or dopamine, 2 microg . kg(-1) . min(-1). We used predetermined hemodynamic and intravascular volume goals (intrathoracic blood volume index 800-1000 mL/m(2), extravascular lung water index <7 mL/kg) to manage patients with an algorithm for use of mannitol and furosemide to maintain urine output >1 mL . kg(-1) . h(-1). At postoperative day 3, the median CRE increase was 0.2 mg/dL (interquartile range [IQR] -0.2-0.5) with fenoldopam and 0.5 mg/dL (IQR 0.3-0.9, P = 0.004) in the dopamine group. The BUN increase was median 2 mg/dL (IQR -2-8) versus 8.5 mg/dL (IQR 5-12, P = 0.01), respectively, with fenoldopam versus dopamine. Urine output was similar; however, significantly fewer fenoldopam patients required furosemide compared with dopamine patients (median 1 [IQR 0-3] versus 3 [IQR 2-4], respectively, P = 0.003). The hemodynamic effects of dopamine and fenoldopam were similar. Compared with dopamine, in the setting of liver transplantation, fenoldopam is associated with better CRE and BUN values.
Rocca
G Della
GD
*Department of Anesthesia, Medical School of Medicine, University of Udine; †Institute of Infectious Diseases, Department of Medical and Morphological Research, University of Udine; and ‡Department of Anesthesia and Intensive Care Unit, University of Rome "La Sapienza," Rome, Italy.
Pompei
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Costa
M G
MG
Coccia
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Scudeller
L
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Marco
P Di
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Monaco
S
S
Pietropaoli
P
P
D058186:Acute Kidney Injury / Q000139:chemically induced / Q000453:epidemiology; D000328:Adult; D000368:Aged; D001806:Blood Urea Nitrogen; D001810:Blood Volume / Q000502:physiology; D016572:Cyclosporine / Q000097:blood; D004232:Diuretics; D004298:Dopamine / Q000009:adverse effects*; D018491:Dopamine Agonists / Q000009:adverse effects*; D005260:Female; D018818:Fenoldopam / Q000009:adverse effects*; D005665:Furosemide; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000097:blood; D007674:Kidney Diseases / Q000139:chemically induced* / Q000453:epidemiology*; D007677:Kidney Function Tests; D016031:Liver Transplantation / Q000502:physiology*; D008297:Male; D008353:Mannitol; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D010865:Pilot Projects; D011183:Postoperative Complications / Q000453:epidemiology; D014563:Urodynamics / Q000187:drug effects
D004232:Diuretics; D018491:Dopamine Agonists; D007166:Immunosuppressive Agents; D008353:Mannitol; D005665:Furosemide; D016572:Cyclosporine; D018818:Fenoldopam; D004298:Dopamine