Fenoldopam reduces the need for renal replacement therapy and in-hospital death in cardiovascular surgery: a meta-analysis.
OBJECTIVE
Acute renal failure is a common and threatening complication in patients undergoing cardiovascular surgery. To determine the efficacy of fenoldopam in the prevention of acute renal failure, the authors performed a systematic review of randomized, controlled trials and propensity-matched studies in patients undergoing cardiovascular surgery.


METHODS
Meta-analysis.


METHODS
Hospitals.


METHODS
A total of 1,059 patients from 13 randomized and case-matched studies were included in the analysis.


METHODS
None.


RESULTS
Google Scholar, PubMed, and scientific sessions were searched (updated November 2006). Authors and external experts were contacted. Four unblinded reviewers selected controlled trials that used fenoldopam in the prevention or treatment of acute renal failure in cardiovascular surgery. Four reviewers independently abstracted patient data, treatment characteristics, and outcomes. Pooled estimates showed that fenoldopam consistently and significantly reduced the need for renal replacement therapy (odds ratio = 0.37 [0.23-0.59], p < 0.001) and in-hospital death (odds ratio = 0.46 [0.29-0.75], p = 0.01). These benefits were associated with shorter intensive care unit stay (weighted mean difference [WMD] = -0.93 days [-1.27; -0.58], p = 0.002). Sensitivity analyses, tests for small study bias, and heterogeneity assessment further confirmed the main analysis.


CONCLUSIONS
This meta-analysis provides evidence that fenoldopam may confer significant benefits in preventing renal replacement therapy and reducing mortality in patients undergoing cardiovascular surgery.
Landoni
Giovanni
G
Department of Cardiothoracic Anesthesia and Intensive Care, Università Vita-Salute San Raffaele, Milano, Italia e Istituto Scientifico San Raffaele, Milan, Italy. landoni.giovanni@hsr.it
Biondi-Zoccai
Giuseppe G L
GG
Marino
Giovanni
G
Bove
Tiziana
T
Fochi
Oliviero
O
Maj
Giulia
G
Calabrò
Maria Grazia
MG
Sheiban
Imad
I
Tumlin
James A
JA
Ranucci
Marco
M
Zangrillo
Alberto
A
D058186:Acute Kidney Injury / Q000517:prevention & control*; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D016022:Case-Control Studies; D003404:Creatinine / Q000097:blood; D018491:Dopamine Agonists / Q000627:therapeutic use*; D005260:Female; D018818:Fenoldopam / Q000627:therapeutic use*; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D016032:Randomized Controlled Trials as Topic; D017582:Renal Replacement Therapy / Q000379:methods / Q000706:statistics & numerical data*; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
D018491:Dopamine Agonists; D003404:Creatinine; D018818:Fenoldopam