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Perioperative fenoldopam for the prevention of acute renal failure in non-cardiac surgery, randomized clinical trial

  • ANTONELLA MEMMO1
  • ANDREA CAROZZO1
  • GIOVANNI LANDONI2
  • GRETA FANO1
  • ORNELLA SOTTOCORNA1
  • ELENA BIGNAMI1
  • VERONICA GIACCHI1
  • LAURA CORNO1
  • SILVIO MAGRIN1
  • ALBERTO ZANGRILLO1

1Università Vita-Salute San Raffaele, Milano Italia e Istituto Scientifico San Raffaele

2,Department of Cardiothoracic Anesthesia and Intensive Care Istituto Scientifico San Raffaele

DOI: 10.22514/SV61.052011.2 Vol.6,Issue 1,May 2011 pp.14-19

Published: 02 May 2011

*Corresponding Author(s): GIOVANNI LANDONI E-mail: landoni.giovanni@hsr.it

Abstract

Purpose. Acute renal failure is a serious complication of surgery causing morbidity and mortality. The aim of this study was to evaluate the efficacy of fenoldopam, a selective dopamine-1 receptor agonist, in patients at high risk of perioperative renal dysfunction. 

Methods. In this prospective single-center randomized double-blind trial we enrolled 64 patients undergoing major sur-gery. Patients received either fenoldopam at a dosage of 0.05 mcg/kg/min or dopamine at a dosage of 2.5 mcg/kg/min after anesthesia induction for a 12-hour period. The primary endpoint was defined as 25% serum creatinine increase from baseline after surgery.

Results. All the patients included were at high risk of perioperative renal dysfunction and underwent major surgery. The two groups (fenoldopam versus dopamine) were homogenous cohorts and no difference in outcome was observed. The incidence of acute renal failure was similar: 11/32 (34%) in the fenoldopam group and 14/32 (44%) in the dopamine group (p=0.6). The postoperative serum creatinine peak was also similar in the two groups. No in-hospital death was observed. Conclusion. Despite an increasing number of reports suggesting renal protective properties of fenoldopam, we observed no difference in clinical outcome compared to dopamine in a high-risk population undergoing major surgery. 

Keywords

fenoldopam, acute renal failure, major surgery, serum crea-tinine

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ANTONELLA MEMMO,ANDREA CAROZZO,GIOVANNI LANDONI,GRETA FANO,ORNELLA SOTTOCORNA,ELENA BIGNAMI,VERONICA GIACCHI,LAURA CORNO,SILVIO MAGRIN,ALBERTO ZANGRILLO. Perioperative fenoldopam for the prevention of acute renal failure in non-cardiac surgery, randomized clinical trial. Signa Vitae. 2011. 6(1);14-19.

References

1. Elliott WJ, Weber RR, Nelson KS, Oliner CM, Fumo Mt, Gretler DD. Renal and hemodynamic effects of intravenous fenoldopam versus nitroprusside in severe hypertension. Circulation 1990;81:970-97.

2. White WB, Halley SE. Comparative renal effects of intravenous administration of fenoldopam mesylate and sodium nitroprusside in patients with severe hypertension. Arch Intern Med 1989;149:870-4.

3. Shusterman NH, Elliott WJ, White WB. Fenoldopam, but not nitroprusside, improves renal function in severely hypertensive patients with impaired renal function. Am J Med 1993;95:161-8.

4. Poinsot O, Romand JA, Favre H, Suter PM. Fenoldopam improves renal hemodynamics impaired by positive end-expiratory pressure. Anesthesiology 1993;79:680-4.

5. Landoni G, Biondi-Zoccai GG, Tumlin JA, Bove T, De Luca M, Calabrò MG, et al. Beneficial impact of fenoldopam in critically ill patients with or at risk for acute renal failure: a meta-analysis of randomized clinical trials. Am J Kidney Dis 2007;49:56-68.

6. Landoni G, Biondi-Zoccai GG, Marino G, Bove T, Fochi O, Maj G, et al. Fenoldopam reduces the need for renal replacement therapy and in-hospital death in cardiovascular surgery: a meta-analysis. J Cardiothorac Vasc Anesth 2008;22:27-33.

7. Roasio A, Lobreglio R, Santin A, Landoni G, Verdecchia C. Fenoldopam reduces the incidence of renal replacement therapy after cardiac surgery. J Cardiothorac Vasc Anesth 2008;22:23-6.

8. Cogliati AA, Vellutini R, Nardini A, Urovi S, Hamdan M, Landoni G, et al. Fenoldopam infusion for renal protection in high risk cardiac surgery patients. A randomized clinical study. J Cardiothorac Vasc Anesth 2007;21:847-50.

9. Bove T, Landoni G, Calabrò MG, Aletti G, Marino G, Cerchierini E, et al. Renoprotective action of fenoldopam in high-risk patients undergo-ing cardiac surgery: a prospective, double blind, randomized clinical trial. Circulation 2005;111:3230-5.

10. Oliver WC Jr, Nuttall GA, Cherry KJ, Decker PA, Bower T, Ereth MH. A comparison of fenoldopam with dopamine and sodium nitroprusside in patients undergoing cross-clamping of the abdominal aorta. Anesth Analg 2006;103:833-40.

11. Marenzi G, Marana I, Lauri G, Assanelli E, Grazi M, Campodonico J, et al. The Prevention of Radiocontrast-Agent–Induced Nephropathy by Hemofiltration. N Engl J Med 2003;349:1333-40.

12. Stone GW, McCullough PA, Tumlin JA, Lepor NE, Madyoon H, Murray P, et al; CONTRAST Investigators. Fenoldopam mesylate for the prevention of contrast-induced nephropathy: a randomized controlled trial. JAMA 2003;290:2284-91.

13. Sheinbaum R, Ignacio C, Safi HJ, Estrera A. Contemporary strategies to preserve renal function during cardiac and vascular surgery. Rev Cardiovascular Med 2003;4:S21-8.

14. Tumlin JA, Finkel KW, Murray PT, Samuels J, Cotsonis G, Shaw AD. Fenoldopam mesylate in early acute tubular necrosis: a randomized, double blind, placebo-controlled clinical trial. Am J Kidney Dis 2005;46:26-34.

15. Caimmi PP, Pagani L, Micalizzi E, Fiume C, Guani S, Bernardi M, et al. Fenoldopam for renal protection in patients undergoing cardiopul-monary bypass. J Cardiothorac Vasc Anesth 2003;17:491-4.

16. Biancofiore G, Della Rocca G, Bindi L, Romanelli A, Esposito M, Meacci L, et al. Use of fenoldopam to control renal dysfunction early after liver transplantation. Liver Transpl 2004;10:986-92.

17. Brienza N, Malcangi V, Dalfino L, Trerotoli P, Guagliardi C, Bortone D, et al. A comparison between fenoldopam and low-dose dopamine in early renal dysfunction of critically ill patients. Crit Care Med 2006;34:707-14.

18. Della Rocca G, Pompei L, Costa MG, Coccia C, Scudeller L, Di Marco P, et al. Fenoldopam mesylate and renal function in patients under-going liver transplantation: a randomized, controlled pilot trial. Anesth Analg 2004;99:1604-9.

19. Halpenny M, Rushe C, Breen P, Cunningham AJ, Boucher-Hayes D, Shorten GD. The effects of fenoldopam on renal function in patients undergoing elective aortic surgery. Eur J Anaesthesiol 2002;19:32-9.

20. Morelli A, Ricci Z, Bellomo R, Ronco C, Rocco M, Conti G, et al. Prophylactic fenoldopam for renal protection in sepsis: a randomized, double-blind, placebo-controlled pilot trial. Crit Care Med 2005;33:2451-6.

21. Mathur VS, Swan SK, Lambrecht LJ, Anjum S, Fellmann J, McGuire D, et al. The effects of fenoldopam, a selective dopamine receptor agonist, on systemic and renal hemodynamics in normotensive subjects. Crit Care Med 1999;27:1832-7.

22. Kellum JA. The use of diuretics and dopamine in acute renal failure: a systematic review of the evidence. Crit Care 1997;1:53-9.

23. Kellum JA, Decker JM. Use of dopamine in acute renal failure: a meta-analysis. Crit Care Med 2001;29:1526-31.

24. Meco M, Allaz MC, Cirri S. Effects of Fenoldopam Mesylate Infusion on Splanchnic Perfusion After Myocardial Revascularization on Car-diopulmonary Bypass: An Ultrasound Doppler Study. J Cardiothorac Vasc Anesth 2010 in press

25. Ramakrishna H, Fassl J, Sinha A, Patel P, Riha H, Andritsos M, et al. The year in cardiothoracic and vascular anesthesia: selected highlights from 2009. J Cardiothorac Vasc Anesth 2010;24:7-17.

26. Meco M, Cirri S. Effects of fenoldopam mesylate on central hemodynamics and renal flow in patients undergoing cardiac surgery: color Doppler echocardiographic evaluation. J Cardiothorac Vasc Anesth 2010;24:58-62.

27. Pittarello D, Bonato R, Falasco G, Tiberio I, Gasparetto M, Ori C. Effects of fenoldopam on myocardial function (strain rate) in patients with coronary artery disease undergoing cardiac surgery. Minerva Anestesiol 2010; 76:707-13.

28. Ranucci M, De Benedetti D, Bianchini C, Castelvecchio S, Ballotta A, Frigiola A, et al. Effects of fenoldopam infusion in complex cardiac surgical operations: a prospective, randomized, double-blind, placebo-controlled study. Minerva Anestesiol 2010;76:249-59.

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