doi: 10.1161/CIRCULATIONAHA.104.509141
(Circulation. 2005;111:3230-3235.)
© 2005 American Heart Association, Inc.
Cardiovascular Surgery |
Renoprotective Action of Fenoldopam in High-Risk Patients Undergoing Cardiac Surgery
A Prospective, Double-Blind, Randomized Clinical Trial
From the Department of Cardiovascular Anesthesia, Vita-Salute University of Milan, IRCCS San Raffaele Hospital, Milan, Italy.
Reprint requests to Landoni Giovanni, Department of Cardiovascular Anesthesia, Vita-Salute University of Milan, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy. E-mail landoni.giovanni{at}hsr.it
Received July 29, 2004; de novo received September 24, 2004; revision received February 18, 2005; accepted March 3, 2005.
Background— Acute renal failure is a serious complication of cardiac surgery causing high morbidity and mortality. The aim of this study was to evaluate the usefulness of fenoldopam, a specific agonist of the dopamine-1 receptor, in patients at high risk of perioperative renal dysfunction.
Methods and Results— A prospective single-center, randomized, double-blind trial was performed after local ethical committee approval and after written consent was obtained from 80 patients undergoing cardiac surgery. Patients received either fenoldopam at 0.05 µg/kg per minute or dopamine at 2.5 µg/kg per minute after the induction of anesthesia for a 24-hour period. All these patients were at high risk of perioperative renal dysfunction as indicated by Continuous Improvement in Cardiac Surgery Program score >10. Primary end point was defined as 25% creatinine increase from baseline levels after cardiac surgery. The 2 groups (fenoldopam versus dopamine) were homogeneous cohorts, and no difference in outcome was observed. Acute renal failure was similar: 17 of 40 (42.5%) in the fenoldopam group and 16 of 40 (40%) in the dopamine group (P=0.9). Peak postoperative serum creatinine level, intensive care unit and hospital stay, and mortality were also similar in the 2 groups.
Conclusions— Despite an increasing number of reports of renal protective properties from fenoldopam, we observed no difference in the clinical outcome compared with dopamine in a high-risk population undergoing cardiac surgery.
Key Words: cardiopulmonary bypass • diuretics • anesthesia • fenoldopam • kidney failure, acute
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