Effect of Fenoldopam on Use of Renal Replacement Therapy Among Patients With Acute Kidney Injury After Cardiac Surgery

Abstract

clinicaltrials.gov Identifier: NCT00621790.

Predictions are difficult…especially about AKI

“…Even when looking at a small rise in serum creatinine of 0.3 mg/dl, which would classify as AKI stage 1 according to current Kidney Disease/ Improving Global Outcomes (KDIGO) criteria, acute deterioration in renal function may not be noticeable for >24 h, especially in critically ill patients with fluid accumulation and reduced creatinine generation [4]. These limitations and delays in diagnosis may explain why results from various intervention trials were negative and therapies for AKI are still lacking [5].…”

Management of post-operative acute kidney injury

“…However, a large multi-centre randomised controlled trial of patients undergoing cardiac surgery showed that in patients with AKI fenoldopam did not reduce the need for RRT or 30 day mortality but was associated with increased hypotension (24). Its use is therefore also not currently recommended.…”

Biomarkers for AKI improve clinical practice: yes

“…Therefore, even the perceived small increase in serum creatinine necessary to reach KDIGO stage 1 criteria for AKI reflects a profound and prolonged decreased in GFR. The negative results of trials aiming to improve the renal outcome in patients with already overt AKI is therefore unsurprising, with most of the patients receiving experimental therapy hours to days following the initial renal insult [8,9]. The need of biomarkers, including functional biomarkers that may rapidly detect changes in GFR and biomarkers of injury that may allow detection of subclinical renal insult, is in this regard obvious.…”