Fenoldopam prophylaxis of postoperative acute renal failure in high-risk cardiac surgery patients.

Abstract

BACKGROUND:

Acute renal failure requiring replacement therapy occurs in 1% to 2% of patients who have undergone cardiac surgery with cardiopulmonary bypass and is associated with a very high mortality rate. The aim of this study was to determine if prophylactic treatment with fenoldopam mesylate of patients at high risk of postoperative acute renal failure reduced the incidence of this event.

METHODS:

This was a multicenter, prospective, cohort study in which 108 patients at high risk of postoperative acute renal failure and undergoing cardiac surgery with cardiopulmonary bypass were treated with fenoldopam mesylate (0.08 microg x kg(-1) x min(-1)) starting at the induction of anesthesia and throughout at least the next 24 hours. A homogeneous control group of 108 patients was created using a propensity-score analysis.

RESULTS:

Fenoldopam prophylaxis was significantly associated with a reduction in acute renal failure incidence (from 22% to 11%, p = 0.028), a less pronounced creatinine clearance decrease (p = 0.05), and a lower mortality rate (6.5% versus 15.7%, p = 0.03) by the univariate analysis, but these results were not confirmed by a multivariable analysis. Within the subgroup of patients who suffered a postoperative low output syndrome, fenoldopam prophylaxis was an independent protective factor for postoperative renal failure (odds ratio, 0.14; 95% confidence interval, 0.03 to 0.7; p = 0.017).

CONCLUSIONS:

Given the limitations of a nonrandomized prospective trial, our results support the hypothesis that fenoldopam may reduce the risk of acute renal failure in patients in whom endogenous and exogenous cathecolamines action may induce a renal vascular constrictive condition.

• Authors: Marco Ranucci, Giorgio Soro, Nicoletta Barzaghi, Alessandro Locatelli, Gianbeppe Giordano, Angelo Vavassori, Aldo Manzato, Chiara Melchiorri, Tiziana Bove, Glauco Juliano, Maria Francesca Uslenghi
• Journal: The Annals of thoracic surgery (Ann Thorac Surg) Vol. 78 Issue 4 Pg. 1332-7; discussion 1337-8 (Oct 2004) ISSN: 1552-6259 [Electronic] Netherlands
• PMID: 15464494 (Publication Type: Clinical Trial, Comparative Study, Controlled Clinical Trial, Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)

Chemical References

• Biomarkers
• Dopamine Agonists
• Vasodilator Agents
• Creatinine
• Fenoldopam

Topics

• Acute Kidney Injury (etiology, prevention & control)
• Aged
• Biomarkers
• Cardiac Surgical Procedures
• Cohort Studies
• Creatinine (blood)
• Dopamine Agonists (administration & dosage, therapeutic use)
• Female
• Fenoldopam (administration & dosage, therapeutic use)
• Hospital Mortality
• Humans
• Male
• Middle Aged
• Postoperative Complications (etiology, prevention & control)
• Prospective Studies
• Risk
• Treatment Outcome
• Vasodilator Agents (administration & dosage, therapeutic use)