Fenoldopam reduces the incidence of renal replacement therapy after cardiac surgery.
OBJECTIVE
To investigate whether a continuous 48-hour infusion of fenoldopam, 0.1 mug/kg/min, reduced the need for renal replacement therapy in patients with acute renal injury after cardiac surgery.


METHODS
Case-matched study.


METHODS
Teaching hospital.


METHODS
Ninety-two patients.


METHODS
Patients who developed acute renal injury (defined as serum creatinine doubling or oliguria) after cardiac surgery received a continuous infusion of fenoldopam, 0.1 mug/kg/min, (46 patients) for 48 hours. They were case matched with 46 patients who developed acute renal injury, had similar baseline characteristics, and received standard treatment (hemodynamic support to obtain a mean arterial pressure >60 mmHg, fluid administration to increase central venous pressure >10 mmHg, and loop diuretics to maintain a urine output >0.5 mL/kg/h). Renal replacement therapy was started when acute renal injury became oligoanuric, when serum creatinine increased >4 mg/dL or 3 times basal value, or in the presence of severe hyperkalemia (K >6.5 mmol/L) or severe acidemia (pH < 7).


RESULTS
Patients in the fenoldopam group had a reduced need for renal replacement therapy (8 patients, 17%) with respect to case-matched controls (18 patients, 39%; p = 0.037). The length of intensive care unit stay (median [interquartile range]) was similar in the 2 groups: fenoldopam group, 5 days (3-9 days), and control group, 10 days (3-16 days, p = 0.15).


CONCLUSIONS
Given the limitations of case-matched studies, fenoldopam may be useful in avoiding renal replacement therapy in patients who develop acute renal injury after cardiac surgery.
Roasio
Agostino
A
Cardiothoracic Anesthesia and Intensive Care Unit, Azienda Sanitaria Ospedaliera S. Giovanni Battista, Turin, Italy.
Lobreglio
Rosetta
R
Santin
Agostino
A
Landoni
Giovanni
G
Verdecchia
Claudio
C
D058186:Acute Kidney Injury / Q000188:drug therapy*; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D016022:Case-Control Studies; D003404:Creatinine / Q000097:blood; D018491:Dopamine Agonists / Q000008:administration & dosage*; D005260:Female; D018818:Fenoldopam / Q000008:administration & dosage*; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; 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