A case series of low-dose fenoldopam in seventy cardiac surgical patients at increased risk of renal dysfunction☆

Abstract 

Objective: To evaluate the usefulness of low-dose fenoldopam mesylate in patients at risk of developing renal dysfunction after cardiac surgery requiring cardiopulmonary bypass. Design: A prospective, single-center, observational study. Setting: University teaching hospital. Participants: Seventy patients scheduled for elective cardiac surgery with one or more predefined risk factors for renal dysfunction. Interventions: After induction of anesthesia, fenoldopam (0.03 μg/kg/min) was administered throughout surgery and into the postoperative period, until the patient was stable and weaned from all other vasoactive agents. Perioperatively, fenoldopam was also used as a second-line antihypertensive agent as required. Measurements and Main Results: No patient developed renal failure that required dialysis, whereas 7.1% (5/70) developed non–dialysis-dependent renal dysfunction. Four out of these 5 patients had 2 or more risk factors (9.5%). Higher preoperative creatinine levels, a history of hypertension, myocardial infarction within 5 days of surgery, and a preoperative diagnosis of chronic renal insufficiency were all good predictors of postoperative non–dialysis-dependent renal dysfunction. Discharge serum creatinine levels were lower than preoperative levels (1.16 ± 0.36 mg/dL v 1.26 ± 0.34 mg/dL, p < 0.05). Conclusion: These findings suggest that renal function was preserved in patients at increased risk for renal dysfunction after cardiac surgery when low-dose fenoldopam was used in the perioperative period. However, a randomized, controlled trial is required to establish efficacy. Copyright 2003, Elsevier Science (USA). All rights reserved.

Keywords:  renal dysfunction, renal protection, cardiac surgery, cardiopulmonary bypass, fenoldopam