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Signa Vitae

Journal of Intensive Care and Emergency Medicine

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

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 surgery. 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.

Key words: fenoldopam, acute renal failure, major surgery, serum creatinine

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Renal function and icu

Abstract

Introduction: The mortality of acute renal failure (ARF) is 50-80% in critically ill patients and has not fallen significantly despite numerous advances in critical care strategies and renal replacement technologies over several decades. (1) A major problem with conducting research into acute renal failure (ARF) is the lack of a consensus definition (2). More than 30 different definitions of ARF have been used in the literature. This lack of a common reference point created confusion and made comparisons difficult. The Acute Dialysis Initiative (ADQI) group of experts developed and published a consensus definition of ARF. This definition goes under the acronym of RIFLE. This definition classified the patients with renal dysfunction according to the degree of impairment into patient at risk (R), with injury (I), with failure (F), with sustained loss (L) and with end stage (E) status in relation to their renal function. (2) Rifle criteria were based on changes in the patients’ glomerular filtration rate (GFR) and/or their urine output. (2)
Discussion: The prophylactic and therapeutic use of dopamine, the more studied vasoactive drug, actually has not been supported. For all other vasoactive drugs, at this moment, data available are contradictory and few conclusions can be made. To protect renal function, despite wide use of vasoactive drugs, only the maintenance of adequate volume replacement and perfusion pressure may be certainly recommended.
Conclusion: The use of vasoactive drugs is a pervasive practice in intensive care units, and hence, this area needs suitably powered, multi-center, randomized, placebo-controlled, double-blind studies to provide more rational indications for clinical practice.

Key words: intensive care unit, acute renal failure, renal protection, hemodynamic management, vasoactive drugs, renal replacement therapy

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