Fenoldopam in cardiovascular surgery: A review

Giovanni Landoni, Francesco A. Garozzo, Anna Mizzi, Alberto Zangrillo

Research output: Contribution to journalArticle

Abstract

Acute kidney injury is a serious complication following cardiovascular surgery, resulting in significant in-hospital and long-term morbidity and mortality. The mortality rate is distressingly high despite improvements in intensive care and dialytic technology, but survivors experience an acceptable quality of life. Fenoldopam mesylate is a dopamine A-1 receptor agonist that decreases systemic vascular resistance while increasing renal blood flow. Fenoldopam, used as an antihypertensive drug, has recently demonstrated nephroprotective properties in critically ill patients or during major surgery. Two recent meta-analyses suggested that fenoldopam reduces the need for renal replacement therapy and mortality in critical ill patients and particularly in those undergoing cardiovascular surgery. In the first meta-analysis of 16 randomised clinical trials for a total of 1290 patients, fenoldopam usage reduced all-cause mortality (81/537 [15.1%] vs 110/581 [18.9%], OR=0.64 [0.45-0.91], p=0.01). Another meta-analysis was performed in the specific setting of cardiovascular surgery and included 1059 patients (4 trials were performed in vascular surgery and 9 in cardiac surgery). Fenoldopam dosage varied across studies, being always >0.03 μg/kg/min and most often 0.1 μg/kg/min, reaching 0.3 μg/kg/min. Fenoldopam usage reduced the risk of death and the risk of renal replacement therapy (30/528 [5.7%] in the fenoldopam group vs 71/531 [13.4%] in the control arm (OR=0.37 [0.23-0.59], p

Original languageEnglish
Pages (from-to)223-226
Number of pages4
JournalVascular Disease Prevention
Volume5
Issue number4
Publication statusPublished - Nov 2008

Keywords

  • Acute renal failure
  • Cardiac surgery
  • Diuretics
  • Fenoldopam
  • Kidney
  • Meta-analysis
  • Mortality
  • Renal replacement therapy

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Epidemiology

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