Renoprotective action of fenoldopam in high-risk patients undergoing cardiac surgery: a prospective, double-blind, randomized clinical trial.
BACKGROUND
Acute renal failure is a serious complication of cardiac surgery causing high morbidity and mortality. The aim of this study was to evaluate the usefulness of fenoldopam, a specific agonist of the dopamine-1 receptor, in patients at high risk of perioperative renal dysfunction.


RESULTS
A prospective single-center, randomized, double-blind trial was performed after local ethical committee approval and after written consent was obtained from 80 patients undergoing cardiac surgery. Patients received either fenoldopam at 0.05 microg/kg per minute or dopamine at 2.5 microg/kg per minute after the induction of anesthesia for a 24-hour period. All these patients were at high risk of perioperative renal dysfunction as indicated by Continuous Improvement in Cardiac Surgery Program score >10. Primary end point was defined as 25% creatinine increase from baseline levels after cardiac surgery. The 2 groups (fenoldopam versus dopamine) were homogeneous cohorts, and no difference in outcome was observed. Acute renal failure was similar: 17 of 40 (42.5%) in the fenoldopam group and 16 of 40 (40%) in the dopamine group (P=0.9). Peak postoperative serum creatinine level, intensive care unit and hospital stay, and mortality were also similar in the 2 groups.


CONCLUSIONS
Despite an increasing number of reports of renal protective properties from fenoldopam, we observed no difference in the clinical outcome compared with dopamine in a high-risk population undergoing cardiac surgery.
Bove
Tiziana
T
Department of Cardiovascular Anesthesia, Vita-Salute University of Milan, IRCCS San Raffaele Hospital, Milan, Italy.
Landoni
Giovanni
G
Calabrò
Maria Grazia
MG
Aletti
Giacomo
G
Marino
Giovanni
G
Cerchierini
Elisa
E
Crescenzi
Giuseppe
G
Zangrillo
Alberto
A
D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D004298:Dopamine / Q000494:pharmacology / Q000627:therapeutic use; D018491:Dopamine Agonists / Q000494:pharmacology / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D018818:Fenoldopam / Q000008:administration & dosage* / Q000494:pharmacology; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care; D020011:Protective Agents / Q000627:therapeutic use; D051437:Renal Insufficiency / Q000209:etiology / Q000517:prevention & control*; D012306:Risk; D016896:Treatment Outcome
D018491:Dopamine Agonists; D020011:Protective Agents; D018818:Fenoldopam; D004298:Dopamine