Fenoldopam reduces the incidence of renal replacement therapy after cardiac surgery

Objective: To investigate whether a continuous 48-hour infusion of fenoldopam, 0.1 mu g/kg/min, reduced the need for renal replacement therapy in patients with acute renal injury after cardiac surgery. Design: Case-matched study. Setting: Teaching hospital. Participants: Ninety-two patients. Interventions: Patients who developed acute renal injury (defined as serum creatinine doubling or oliguria) after cardiac surgery received a continuous infusion of fenoldopam, 0.1 mu g/kg/min, (46 patients) for 48 hours. They were case matched with 46 patients who developed acute renal injury, had similar baseline characteristics, and received standard treatment (hemodynamic support to obtain a mean arterial pressure > 60 mmHg, fluid administration to increase central venous pressure > 10 mmHg, and loop diuretics to maintain a urine output > 0.5 mL/kg/h). Renal replacement therapy was started when acute renal injury became oligoanuric, when serum creatinine increased > 4 mg/dL or 3 times basal value, or in the presence of severe hyperkalemia (K > 6.5 mmol/L) or severe acidemia (pH < 7). Measurements and Main Results: Patients in the fenoldopam group had a reduced need for renal replacement therapy (8 patients, 17%) with respect to case-matched controls (18 patients, 39%; p = 0.037). The length of intensive care unit stay (median [interquartile range]) was similar in the 2 groups: fenoldopam group, 5 days (3-9 days), and control group, 10 days (3-16 days, p = 0.15). Conclusions: Given the limitations of case-matched studies, fenoldopam may be useful in avoiding renal replacement therapy in patients who develop acute renal injury after cardiac surgery. (c) 2008 Elsevier Inc. All rights reserved.