Prophylactic fenoldopam for renal protection in sepsis: a randomized, double-blind, placebo-controlled pilot trial.
OBJECTIVE
Acute renal failure is common in septic patients. Fenoldopam, a dopamine-1 receptor agonist, increases renal blood flow and may, therefore, reduce the risk of acute renal failure in such patients. Accordingly, we sought to determine the safety and efficacy of fenoldopam for the prevention of acute renal failure in septic patients.


METHODS
Prospective, double-blind, placebo-controlled trial.


METHODS
Three multidisciplinary intensive care units at a university hospital.


METHODS
Three hundred septic patients with baseline serum creatinine concentrations <150 micromol/L.


METHODS
We randomized patients to a continuous infusion of either fenoldopam (n = 150) at 0.09 microg x kg x min or placebo (n = 150) while in the intensive care unit. The primary outcome measure was the incidence of acute renal failure, defined as a serum creatinine concentration increase to >150 micromol/L, during study drug infusion.


RESULTS
The incidence of acute renal failure was significantly lower in the fenoldopam group compared with the control group (29 vs. 51 patients; p = .006). The odds ratio of developing acute renal failure for patients treated with fenoldopam was estimated to be 0.47 (p = .005). The difference in the incidence of severe acute renal failure (creatinine >300 mumol/L), however, failed to achieve statistical significance (10 vs. 21; p = .056). The length of intensive care unit stay in surviving patients was significantly lower in the fenoldopam group compared with the control group (10.64 +/- 9.3 vs. 13.4 +/- 14.0; p < .001). There were no complications of fenoldopam infusion. A direct effect of treatment on the probability of death, beyond its effect on acute renal failure, was not significant (odds ratio = 0.68, p = .1).


CONCLUSIONS
Compared with placebo, low-dose fenoldopam resulted in a smaller increase in serum creatinine in septic patients. The clinical significance of this finding is uncertain. A large multiple-center trial is now needed to confirm these findings.
Morelli
Andrea
A
Department of Anesthesiology and Intensive Care, University of Rome La Sapienza, Rome, Italy.
Ricci
Zaccaria
Z
Bellomo
Rinaldo
R
Ronco
Claudio
C
Rocco
Monica
M
Conti
Giorgio
G
De Gaetano
Andrea
A
Picchini
Umberto
U
Orecchioni
Alessandra
A
Portieri
Monica
M
Coluzzi
Flaminia
F
Porzi
Patrizia
P
Serio
Paola
P
Bruno
Annunziata
A
Pietropaoli
Paolo
P
D058186:Acute Kidney Injury / Q000209:etiology / Q000517:prevention & control*; D003404:Creatinine / Q000097:blood; D018491:Dopamine Agonists / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D018818:Fenoldopam / Q000627:therapeutic use*; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D018805:Sepsis / Q000150:complications
D018491:Dopamine Agonists; D003404:Creatinine; D018818:Fenoldopam