Fenoldopam infusion for renal protection in high-risk cardiac surgery patients: a randomized clinical study.
OBJECTIVE
The purpose of this study was to evaluate the renoprotective effects of fenoldopam in patients at high risk of postoperative acute kidney injury undergoing elective cardiac surgery requiring cardiopulmonary bypass.


METHODS
A double-blind randomized clinical trial.


METHODS
Hospital.


METHODS
One hundred ninety-three patients.


METHODS
Patients undergoing cardiac surgery were randomly assigned to receive a continuous infusion of fenoldopam, 0.1 microg/kg/min (95 patients), or placebo (98 patients) for 24 hours. Patients were included if at least 1 of the following risk factors was present: preoperative serum creatinine > or =1.5 mg/dL, age >70 years, diabetes mellitus, or prior cardiac surgery. Serum creatinine and urinary output were measured at baseline (T1), 24 hours (T2), and 48 hours after surgery (T3). Acute kidney injury was defined as a postoperative serum creatinine level of > or =2 mg/dL with an increase in serum creatinine level of 0.7 mg/dL or greater from preoperative to maximum postoperative values.


RESULTS
Acute kidney injury developed in 12 of 95 (12.6%) patients receiving fenoldopam and in 27 of 98 (27.6%) patients receiving placebo (p = 0.02), whereas renal replacement therapy was started in 0 of 95 and 8 of 98 (8.2%) patients, respectively (p = 0.004). Serum creatinine was similar at baseline (1.8 +/- 0.4 mg/dL v 1.9 +/- 0.3 mg/dL) in the fenoldopam and placebo groups but differed significantly (p < 0.001 and p < 0.001) 24 hours (1.6 +/- 0.2 mg/dL v 2.5 +/- 0.6 mg/dL) and 48 hours (1.5 +/- 0.3 mg/dL v 2.8 +/- 0.4 mg/dL) after the operation.


CONCLUSIONS
A 24-hour infusion of 0.1 mug/kg/min of fenoldopam prevented acute kidney injury in a high-risk population undergoing cardiac surgery.
Cogliati
Andrea A
AA
Department of Anesthesia and Intensive Care, Villa Maria Cecilia Hospital, Cotignola, Ravenna, Italy.
Vellutini
Raffaella
R
Nardini
Antonia
A
Urovi
Sali
S
Hamdan
Mazen
M
Landoni
Giovanni
G
Guelfi
Paolo
P
D000368:Aged; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D003404:Creatinine / Q000097:blood; D005260:Female; D018818:Fenoldopam / Q000008:administration & dosage*; D005440:Fluid Therapy / Q000706:statistics & numerical data; D006801:Humans; D007262:Infusions, Intravenous; D007674:Kidney Diseases / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D017582:Renal Replacement Therapy; D012307:Risk Factors; D013997:Time Factors; D014665:Vasodilator Agents / Q000008:administration & dosage*
D014665:Vasodilator Agents; D003404:Creatinine; D018818:Fenoldopam