Fenoldopam prophylaxis of postoperative acute renal failure in high-risk cardiac surgery patients |
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Authors: | Ranucci Marco Soro Giorgio Barzaghi Nicoletta Locatelli Alessandro Giordano Gianbeppe Vavassori Angelo Manzato Aldo Melchiorri Chiara Bove Tiziana Juliano Glauco Uslenghi Maria Francesca |
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Affiliation: | a Cardiothoracic Anesthesia and Intensive Care, Istituto Policlinico S. Donato, Milan, Italy b Cardiac Surgery Intensive Care Unit, Azienda Ospedaliera S. Croce and Carle, Cuneo, Italy c Anesthesia and Intensive Care Unit, Villa Maria Pia Hospital, Turin, Italy d Anesthesia and Intensive Care I, Ospedali Riuniti, Bergamo, Italy e Cardiac Anesthesia and Intensive Care, Spedali Civili, Brescia, Italy f Cardiovascular Intensive Care Unit, Ospedale Mauriziano Umberto I, Turin, Italy g Cardiovascular Anesthesia and Intensive Care, IRCCS San Raffaele Hospital, Milan, Italy h Anesthesia and Intensive Care, IRCCS Centro Cardiologico Monzino, Milan, Italy i Anesthesia and Intensive Care A, Ospedale di Circolo e Fondazione Macchi, Varese, Italy |
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Abstract: | BackgroundAcute 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.MethodsThis 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 μg · kg−1 · 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.ResultsFenoldopam 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).ConclusionsGiven 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. |
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Keywords: | 25 |
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