Preventing contrast-induced nephropathy with fenoldopam

Hunter, David W.; Chamsuddin, Abbas; Bjarnason, Haraldur; Kowalik, Karen

doi:10.1053/tvir.2001.21994

Cited by 17 publications

(18 citation statements)

References 14 publications

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“…Observational studies reported rather low rates of CIN in high-risk patients treated with fenoldopam [17,75,76]. In a double-blind, randomized, placebo-controlled pilot trial [77], the combination of fenoldopam and hydration, compared with hydration alone, resulted in an increase in renal plasma flow, a decrease in peak serum creatinine level 72 hr after exposure to contrast media, and a trend toward decreased incidence of CIN (21% and 41%, respectively; P ¼ 0.14).…”

Section: Fenoldopammentioning

confidence: 99%

Contrast‐induced nephropathy

Pučelíková

Dangas

Mehran

2007

Cathet Cardio Intervent

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Contrast induced nephropathy (CIN) is an iatrogenic disorder, resulting from exposure to contrast media. Contrast-induced hemodynamic and direct cytotoxic effects on renal structures are highly evident in its pathogenesis, whereas other mechanisms are still poorly understood. CIN is typically defined as an increase in serum creatinine by either 0.5 mg/dl or by 25% from baseline within the first 2-3 days after contrast administration. Although rare in the general population, CIN has a high incidence in patients with an underlying renal disorder, in diabetics, and the elderly. The risk factors are synergistic in their ability to produce CIN. The best way to prevent CIN is to identify the patients at risk and to provide adequate peri-procedural hydration. The role of various drugs in prevention of CIN is still controversial and warrants future studies. Despite remaining uncertainty regarding the degree of nephrotoxicity produced by various contrast agents, in current practice non-ionic low-osmolar contrast media are preferred over the high-osmolar contrast media in patients with renal impairment.

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Section: Fenoldopammentioning

confidence: 99%

Contrast‐induced nephropathy

Pučelíková

Dangas

Mehran

2007

Cathet Cardio Intervent

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“…Animal testing with fenoldopam has indicated that it is six times more potent than dopamine in its ability to decrease renal vascular resistance; this suggests that it could be a much more selective and potent renal protective agent against any toxin or stimulus that causes renal dysfunction by reducing renal blood flowor increasing renal ischemia. Fenoldopam has been used for patients who were thought to be at the highest risk for contrast-induced nephropathy, and results suggest that fenoldopam may be of distinct benefit to high-risk patients who need intravascular contrast, especially those who may have to receive a large contrast dose, such as patients undergoing renal angiography [19]. Because available data are anecdotal, it is desirable that prospective, randomized trials are conducted to compare the effects of fenoldopam with those of hydration.…”

Section: Spiral Computed Tomographic Angiographymentioning

confidence: 99%

Ischemic nephropathy: Detection and therapeutic intervention

García-Donaire

Alcázar

2005

Kidney International

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Although the real prevalence of ischemic nephropathy as a cause of end-stage renal disease is unknown, its incidence has increased in past years. The diagnosis of this pathology requires that a number of functional and anatomic tests be carried out. The initial approach should be to perform duplex Doppler ultrasonography which, besides providing data on the size and extent of the stenosis, enables the intrarenal resistive index to be estimated to determine the pattern of renal parenchyma injury and the expected progression if revascularized. The most frequently used morphologic techniques are magnetic resonance angiography and computer tomography angiography. In the event of ischemic neuropathy, it is necessary to perform a renal arteriography regardless of the inherent risks of contrast toxicity or atheroembolism. Various therapeutic options are reviewed, with emphasis on percutaneous transluminal renal angiography plus stent as the first indication. Even though initial reports were contradictory, several meta-analyses have concluded that better blood pressure control and renal function improvement are achieved with percutaneous transluminal renal angiography plus stent than with conventional medical therapy. Surgical revascularization is preferable in patients with severe aorto-iliac pathology and renal artery ostium complete thrombosis. The risks and benefits of these procedures must be evaluated on an individual basis.

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“…[13,24,25] Other trials using fenoldopam to prevent ARF from radio contrast in high-risk individuals are also supportive. [12,15] However, a recent randomized controlled trial failed to document any efficacy of fenoldopam to prevent radio-contrast nephropathy. [14] In addition, there may exist a dose-response effect to the renoprotection of fenoldopam.…”

Section: Discussionmentioning

confidence: 99%

Effect of Fenoldopam Mesylate in Critically Ill Patients at Risk for Acute Renal Failure is Dose Dependent

Samuels¹,

Finkel

Gubert

et al. 2005

Renal Failure

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Background: Acute renal failure (ARF) is common and difficult to prevent, especially in intensive care unit (ICU) patients with cancer. Therapeutic trials with various agents have generally been ineffective in preventing ARF. We describe the effects of two different doses of the dopamine DA-1 receptor agonist fenoldopam mesylate on renal function in a series of critically ill cancer patients at risk of developing ARF. Methods: We performed a retrospective chart review of 100 consecutive patients who received fenoldopam mesylate for at least 72 h in the medical and surgical ICUs of The University of Texas M. D. Anderson Cancer Center who were at risk of developing ARF. Eighteen patients received low-dose fenoldopam mesylate ( 0.05 mg/kg/min). The remaining 82 patients received high-dose fenoldopam mesylate (0.07 -0.1 mg/kg/min). Data were collected relating to drug dosage, patient demographics, severity of illness, and indices of renal function. Results: Patients were moderately ill, with a mean APACHE II score of 18 ± 6 at initiation of fenoldopam infusion. Eighty-five percent of patients had at least two risk factors for the development of ARF, and 20% had four. For the group overall, the incidence of ARF was 13%, and the hospital mortality rate was 37%. When compared with the low-dose group, patients who received highdose fenoldopam had a significantly shorter ICU length of stay despite a significantly higher APACHE II score ( p = 0.01). The high-dose group also had a highly significant decrease in serum creatinine levels at 72 h ( p = 0.005). Conclusions: These data support the hypothesis that fenoldopam mesylate may provide a degree of dose-dependent renal protection in cancer patients with early acute renal failure.

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Preventing contrast-induced nephropathy with fenoldopam

Cited by 17 publications

References 14 publications

Contrast‐induced nephropathy

Contrast‐induced nephropathy

Ischemic nephropathy: Detection and therapeutic intervention

Effect of Fenoldopam Mesylate in Critically Ill Patients at Risk for Acute Renal Failure is Dose Dependent

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