Effects of fenoldopam on kidney function parameters and its therapeutic efficacy in the management of acute kidney injury in dogs with heatstroke

Abstract

BackgroundAcute kidney injury (AKI) is common in dogs, but evidence of efficacy of its treatment is lacking.ObjectiveTo evaluate the efficacy of fenoldopam in the management of AKI.AnimalsForty dogs with naturally occurring heatstroke.MethodsDogs were prospectively enrolled and divided into treatment and the placebo groups (fenoldopam, constant rate infusion [CRI] of 0.1 µg/kg/min or saline, respectively). Urine production (UP) was measured using a closed system. Urinary clearances were performed at 4, 12, and 24 hours after presentation to estimate the effect of fenoldopam on UP, glomerular filtration rate (GFR) and sodium fractional excretion (NaFE).ResultsAt presentation, severity of heatstroke, based on a previously developed scoring system, was similar between the study groups, but was significantly worse in nonsurvivors compared with survivors. Fenoldopam administration was not associated with hypotension. Overt AKI was diagnosed, based on the International Renal Interest Society guidelines in 22/40 (55%) of the dogs. Overall, 14/40 dogs (35%) died, with no significant (P = .507) mortality rate difference between the fenoldopam (6/20 dogs; 30%) and placebo (8/20; 40%) groups. The proportion of dogs with AKI did not differ between the fenoldopam and the placebo groups (9/20; 45% versus 13/20; 65%, respectively; P = .204). There were no differences in UP, GFR, and NaFE between the fenoldopam and the placebo groups.Conclusion and Clinical ImportanceFenoldopam CRI at 0.1 µg/kg/min did not have a clinically relevant effect on kidney function parameters in dogs with severe heatstroke‐associated AKI.

Incidence and risk factors for heat-related illness (heatstroke) in UK dogs under primary veterinary care in 2016

“…Male dogs develop higher body temperature post exercise 34,36 , and are over represented in cases of heatstroke presenting to veterinary hospitals 10,13,37 .…”

Sequential changes in urine production, glomerular filtration rate, and electrolyte excretion after mannitol administration

“…Solute diuresis might be beneficial in the management of AKI patients because it decreases sodium reabsorption and therefore energy demands. Sodium FE, however, increases in dogs with AKI even when mannitol is not administered and to substantially higher levels …”

“…Sodium FE, however, increases in dogs with AKI even when mannitol is not administered and to substantially higher levels. 8,19 The FE of urea also increased significantly after bolus administration, most likely because of decreased urea reabsorption in the renal tubules.…”

“…The use of dopamine is controversial, and it no longer is used routinely in human patients . Recently, fenoldopam has been evaluated in human and veterinary patients with conflicting results …”

“…5 Recently, fenoldopam has been evaluated in human and veterinary patients with conflicting results. [6][7][8] Mannitol is an osmotic diuretic, widely used in the management of AKI, both as a bolus injection and as a constant rate infusion (CRI). 4 Potential beneficial effects of its use include increases in glomerular filtration rate (GFR), renal blood flow, and tubular flow.…”