A comparison between fenoldopam and low-dose dopamine in early renal dysfunction of critically ill patients.
OBJECTIVE
Fenoldopam mesylate is a selective dopamine-1 agonist, with no effect on dopamine-2 and alpha1 receptors, producing a selective renal vasodilation. This may favor the kidney oxygen supply/demand ratio and prevent acute renal failure. The aim of the study was to investigate if fenoldopam can provide greater benefit than low-dose dopamine in early renal dysfunction of critically ill patients.


METHODS
Prospective, multiple-center, randomized, controlled trial.


METHODS
University and city hospital intensive care units.


METHODS
One hundred adult critically ill patients with early renal dysfunction (intensive care unit stay<1 wk, hemodynamic stability, and urine output<or=0.5 mL/kg over a 6-hr period and/or serum creatinine concentration>or=1.5 mg/dL and<or= 3.5 mg/dL).


METHODS
Patients were randomized to receive 2 microg/kg/min dopamine (group D) or 0.1 microg/kg/min fenoldopam mesylate (group F). Drugs were administered as continuous infusion over a 4-day period.


RESULTS
Systemic hemodynamic and renal function variables were recorded daily. The two groups were well matched at enrollment for illness severity and hemodynamic and renal dysfunction. No differences in heart rate or systolic, diastolic, or mean arterial pressure were observed between groups. Fenoldopam produced a more significant reduction in creatinine values compared with dopamine after 2, 3, and 4 days of infusion (change from baseline at time 2, -0.32 vs. -0.03 mg/dL, p=.047; at time 3, -0.45 vs. -0.09 mg/dL, p=.047; and at time 4, -.041 vs. -0.09 mg/dL, p=.02, in groups F and D, respectively). The maximum decrease in creatinine compared with baseline was significantly greater in group F than group D (-0.53+/-0.47 vs. -0.34+/-0.38 mg/dL, p=.027). Moreover, 66% of patients in group F had a creatinine decrease>10% of the baseline value at the end of infusion, compared with only 46% in dopamine group (chi-square=4.06, p=.04). Total urinary output during drug infusion was not significantly different between groups. After 1 day, urinary output was lower in group F compared with group D (p<.05).


CONCLUSIONS
In critically ill patients, a continuous infusion of fenoldopam at 0.1 microg/kg/min does not cause any clinically significant hemodynamic impairment and improves renal function compared with renal dose dopamine. In the setting of acute early renal dysfunction, before severe renal failure has occurred, the attempt to reverse renal hypoperfusion with fenoldopam is more effective than with low-dose dopamine.
Brienza
Nicola
N
Anesthesia and Intensive Care Division, Emergency and Organ Transplantation Department, University of Bari, and Anesthesia and Intensive Care Division, Miulli Hospital, Acquaviva delle Fonti, Italy.
Malcangi
Vincenzo
V
Dalfino
Lidia
L
Trerotoli
Paolo
P
Guagliardi
Clementina
C
Bortone
Dora
D
Faconda
Giuseppe
G
Ribezzi
Mario
M
Ancona
Giovanni
G
Bruno
Francesco
F
Fiore
Tommaso
T
D058186:Acute Kidney Injury / Q000188:drug therapy* / Q000517:prevention & control; D000368:Aged; D016638:Critical Illness; D004298:Dopamine / Q000627:therapeutic use*; D018491:Dopamine Agonists / Q000627:therapeutic use*; D005260:Female; D018818:Fenoldopam / Q000627:therapeutic use*; D006801:Humans; D007262:Infusions, Intravenous; D016014:Linear Models; D008297:Male; D015999:Multivariate Analysis; D011446:Prospective Studies; D012076:Renal Agents / Q000627:therapeutic use*
D018491:Dopamine Agonists; D012076:Renal Agents; D018818:Fenoldopam; D004298:Dopamine