Monday February 13, 2006
Renal dose Fenoldopam ?
We are done with renal dose dopamine but than we heard about renal dose norepinephrine1 and now renal dose fenoldopam? Look at this study of 300 septic patients with baseline serum creatinine concentrations less than 150 umol/L (2 mg/dL)*.
150 patients with a continuous infusion of fenoldopam at 0.09 μg·kg-1·min-1 (nonhemodynamic dose) has been compared with 150 placebo patients. The primary outcome measure was the incidence of acute renal failure, defined as a serum creatinine concentration increase to >150 μmol/L (>2 mg/dL), during study drug infusion. The incidence of acute renal failure was significantly lower in the fenoldopam group compared with the control group (29 vs. 51 patients; p = .006). Also, the length of ICU stay in surviving patients was significantly lower in the fenoldopam group compared with the control group (10.64 vs. 13.4; p < .001). Its not clear why fenoldopam which is also a dopaminergic agonist like low-dose dopamine, has protective effect on kidney but dopamine does not. We need a large multiple-center trial to have more answers.
* 1 mg/dL = 88.4 mol/L of serum Cr.
References:Click to get article/abstract (second popup overwrites first popup)
1. Renal Dose Norepinephrine! - Chest. 2004;126:335-337
2. Prophylactic fenoldopam for renal protection in sepsis: A randomized, double-blind, placebo-controlled pilot trial - Critical Care Medicine: Volume 33(11) November 2005 pp 2451-2456