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Fenoldopamin in cardiac surgery

Fenoldopamin in der Herzchirurgie

  • Published:
Clinical Research in Cardiology Supplements Aims and scope

Zusammenfassung

Fenoldopam-Mesylat ist eine blutdrucksenkende Arznei mit einem diuretischen Effekt. In diesem Review sollen die evidenzbasierten Fakten über den Einsatz von Fenoldopam bei chirurgischen Herzpatienten und/oder bei kritisch kranken Patienten mit der Gefahr eines akuten Nierenversagens (ARF) dargestellt werden.

Aus den bisher vorliegenden Studien zeigt sich, dass Fenoldopam für an ARF leidende Patienten vorteilhaft sein könnte, wenn es frühzeitig eingesetzt wird und eine verlängerte Infusionsphase vorliegt.

Bei herzchirurgischen Patienten liegen noch keine abschließenden Studien vor, die die Wirksamkeit belegen. Daher ist eine große Multicenter-randomisierte Studie (RCT) notwendig, um die vielversprechenden aber zum Teil widersprüchlichen Effekte dieses Medikaments zu untersuchen.

Summary

Fenoldopam mesylate is a useful antihypertensive and diuretic drug. In this review, we examine the evidence based medicine wheter to use fenoldopam in cardiac surgery patients and/or in critically ill patients with or at risk for acute renal failure (ARF). We conclude that from published studies it seems that fenoldopam could be beneficial if a prolonged infusion is performed starting early in the process of ARF in critically ill patients. Unfortunately there is still virtually no definitive evidence of efficacy, especially in cardiac surgery patients. A large, multicenter, randomized, controlled trial (RCT) is needed to confirm the promising but conflicting findings of this drug.

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References

  1. Bhat JG, Gluck MC, Lowenstein J, Baldwin DS (1976) Renal failure after open heart surgery. Ann Intern Med 84:677–682

    PubMed  CAS  Google Scholar 

  2. Biancofiore G, Della Rocca G, Bindi I et al (2004) Use of fenoldopam to control renal dysfunction early after liver transplantation. Liver Transpl 10:986–992

    Article  PubMed  Google Scholar 

  3. Bove T, Landoni G, Calabro MG et al (2005) Renoprotective action of fenoldopam in high-risk patients undergoing cardiac surgery: a prospective, double-blind, randomized clinical trial. Circulation 111:3230–3235

    Article  PubMed  CAS  Google Scholar 

  4. Brienza N, Malcangi V, Dalfino L et al (2006) A comparison between fenoldopam and low dose dopamine in early renal dysfunction of critically ill patients. Crit Care Med 34:707–714

    Article  PubMed  CAS  Google Scholar 

  5. Brienza N, Malcangi V, Faconda G et al (2003) Effects of fenoldopam in early renal dysfunction (ERD) in critically ill patients with chronic hypertension. Minerva Anestesiologica 69(suppl 2):A326

    Google Scholar 

  6. Caimmi PP, Pagani L, Micalizzi E et al (2003) Fenoldopam for renal protection in patients undergoing cardiopulmonary bypass. J Cardiothorac Vasc Anesth 17:491–494

    Article  PubMed  Google Scholar 

  7. Chertow GM, Levy EM, Hammermeister KE, Grover F, Daley JA (1998) Independent association between acute renal failure and mortality following cardiac surgery. Am J Med 104:343–348

    Article  PubMed  CAS  Google Scholar 

  8. Corwin HL, Sprague SM, DeLaria GA, Norusis MJ (1989) Acute renal failure associated with cardiac operations. A case-control study. J Thorac Cardiovasc Surg 98:1107–1112

    PubMed  CAS  Google Scholar 

  9. Della Rocca G, Pompei L, Costa MG et al (2004) Fenoldopam mesylate and renal function in patients undergoing liver transplantation: a randomized, controlled pilot trial. Anesth Analg 99:1604–1609

    Article  PubMed  CAS  Google Scholar 

  10. Della Rocca G, Pompei L, Monaco S et al (2002) Renal protection and liver transplantation. Anesthesiology 96:A415

    Google Scholar 

  11. Doggrell SA (2002) The therapeutic potential of dopamine modulators on the cardiovascular and renal systems. Expert Opin Investig Drugs 11:631–644

    Article  PubMed  CAS  Google Scholar 

  12. Elliott WJ, Weber RR, Nelson KS, Oliner CM, Fumo Mt, Gretler DD (1990) Renal and hemodynamic effects of intravenous fenoldopam versus nitroprusside in severe hypertension. Circulation 81:970–997

    PubMed  CAS  Google Scholar 

  13. Gailiunas P, Chawla R, Lazarus JM, Cohn L, Sanders J, Merrill JP (1980) Acute renal failure following cardiac operations. J Thorac Cardiovasc Surg 79:241–243

    PubMed  Google Scholar 

  14. Garwood S, Davis E, Hines RL (1997) Fenoldopam: aneffective renal preservation agent in cardiac surgery? Anesthesiology 91:A154

    Google Scholar 

  15. Gastaldo P, Launo C (2004) Funzionalità renale durante anestesia generale in chirurgia aortica Minerva Anestesiologica 70 (suppl 2):A42–45

    Google Scholar 

  16. Gombotz H, Plaza J, Mahla E, Berger J, Metzler H (1998) DA1-receptor stimulation by fenoldopam in the treatment of postcardiac surgical hypertension. Acta Anaesthesiol Scand 42:834–840

    Article  PubMed  CAS  Google Scholar 

  17. Halpenny M, Lakshmi S, O'Donnell A, O'Callaghan-Enright S, O'Connell D, Shorten G (2001) The effects of fenoldopam on coronary conduit blood flow after coronary artery bypass graft surgery. J Cardiothorac Vasc Anesth 15:72–76

    Article  PubMed  CAS  Google Scholar 

  18. Halpenny M, Lakshmi S, O'Donnell A, O'Callaghan-Enright S, Shorten G (2001) Fenoldopam: renal and splanchnic effects in patients undergoing coronary artery bypass grafting. Anaesthesia 56:953–960

    Article  PubMed  CAS  Google Scholar 

  19. Halpenny M, Rushe C, Breen P, Cunningham AJ, Boucher-Hayes D, Shorten GD (2002) The effects of fenoldopam on renal function in patients undergoing elective aortic surgery. Eur J Anaesthesiol 19:32–39

    Article  PubMed  CAS  Google Scholar 

  20. Hill A J, Feneck RO, Walesby RK (1993) A comparison of fenoldopam and nitroprusside in the control of hypertension following coronary artery surgery. J Cardiothorac Vasc Anesth 7:279–284

    Article  PubMed  CAS  Google Scholar 

  21. Kaplan JA, Reich DL, Konstadt SN (1999) Cardiac Anesthesia Fourth Edition. WB Saunders Co, Philadelphia, PA, pp 1074–1075

  22. Kini AS, Mitre CA, Kamran M, Suleman J, Kim M, Duffy ME (2002) Changing trends in incidence and predictors of radiographic contrast nephropathy after percutaneous coronary intervention with use of fenoldopam. Am J Cardiol 89:999–1002

    Article  PubMed  Google Scholar 

  23. Madyoon H, Croushore L, Weaver D, Mathur V (2001) Use of fenoldopam to prevent radiocontrast nephropathy in high-risk patients. Catheter Cardiovasc Interv 53:341–345

    Article  PubMed  CAS  Google Scholar 

  24. Malcangi V, Dalfino L, Perchiazzi G, Di Venosa C, Pugliese V, Brienza N (2004) Disfunzione renale da shock: effetto nefroprotettivo del fenoldopam. Minerva Anestesiologica 70 (suppl 2):A361

    Google Scholar 

  25. Mangano CM, Diamondstone LS, Ramsay JG, Aggarwal A, Herskowitz A, Mangano DT (1998) Renal dysfunction after myocardial revascularization: risk factors, adverse outcomes, and hospital resource utilization. The multicenter study of perioperative ischemia research group. Ann Intern Med 128:194–203

    PubMed  CAS  Google Scholar 

  26. McCune TR, Wombolt DG, Whelan TV, Thacker LR, Colonna JO (2005) Vasodilatation vs immunotherapy to prevent delayed graft function: delayed graft function as an indication of immune activation. Int Immunopharmacol 5:85–92

    Article  PubMed  CAS  Google Scholar 

  27. Morelli A, Ricci Z, Bellomo et al (2005) Prophylactic fenoldopam for renal protection in sepsis: a randomized, double-blind, placebo-controlled pilot trial. Crit Care Med 33:2451–2456

    Article  PubMed  CAS  Google Scholar 

  28. Morelli A, Rocco M, Conti G et al (2004) Effects of short-term fenoldopam infusion on gastric mucosal blood flow in septic shock. Anesthesiology 101:576–582

    Article  PubMed  CAS  Google Scholar 

  29. Murphy MB, Murray C, Shorten GD (2001) Fenoldopam: a selective peripheral dopamine-receptor agonist for the treatment of severe hypertension. N Engl J Med 345:1548–1557

    Article  PubMed  CAS  Google Scholar 

  30. Pittarello D, Bonato R, Falasco G et al (2003) Studio degli effetti del fenoldopam in pazienti con lieve insufficienza renale sottoposti ad intervento chirurgico. Minerva Anestesiologica 69 (suppl 2):A162

    Google Scholar 

  31. Poinsot O, Romand JA, Favre H, Suter PM (1993) Fenoldopam improves renal hemodynamics impaired by positive end-expiratory pressure. Anesthesiology 79:680–684

    Article  PubMed  CAS  Google Scholar 

  32. Ranucci M, Soro G, Barzaghi N et al (2004) Fenoldopam prophylaxis of postoperative acute renal failure in high-risk cardiac surgery patients. Ann Thorac Surg 78:1332–1337

    Article  PubMed  Google Scholar 

  33. Renzini M, Fontanelli S, Manini E et al (2004) Fenoldopam in cardiochirurgia. Minerva Anestesiologica 70 (suppl 2): A269

    Google Scholar 

  34. Sheinbaum R, Ignacio C, Safi HJ, Estrera A (2003) Contemporary strategies to preserve renal function during cardiac and vascular surgery. Rev Cardiovasc Med 4 (suppl 1):S21–28

    PubMed  Google Scholar 

  35. Sheinbaum R, Safi H, Ignacio C, Carter J, Reyna R (2000) Renal protection and improved outcome by utilization of a DA-1 agonist (fenoldopam) in TAAA repair. Anaesth Analg 90 (suppl:)SCA31

  36. Shusterman NH, Elliott WJ, White WB (1993) Fenoldopam, but not nitroprusside, improves renal function in severely hypertensive patients with impaired renal function. Am J Med 95:161–168

    Article  PubMed  CAS  Google Scholar 

  37. Stone GW, McCullough PA, Tumlin JA, Lepor NE, Madyoon H, Murray P, Wang A, Chu AA, Schaer GL, Stevens M, Wilensky RL, O'Neill WW (2003) Fenoldopam mesylate for the prevention of contrast-induced nephropathy: a randomized controlled trial. JAMA 290:2284–2291

    Article  PubMed  CAS  Google Scholar 

  38. Taylor AA, Shepherd AM, Polvino W, et al (1999) Prolonged fenoldopam infusions in patients with mild to moderate hypertension: pharmacodynamic and pharmacokinetic effects. Am J Hypertens 12:906–914

    Article  PubMed  CAS  Google Scholar 

  39. Tumlin JA, Finkel KW, Murray PT, Samuels J, Cotsonis G, Shaw AD (2005) Fenoldopam mesylate in early acute tubular necrosis: a randomized, double-blind, placebo-controlled clinical trial. Am J Kidney Dis 46:26–34

    Article  PubMed  CAS  Google Scholar 

  40. Weber RR, McCoy CE, Ziemniak JA, Frederickson ED, Goldberg LI, Murphy MB (1988) Pharmacokinetic and pharmacodynamic properties of intravenous fenoldopam, a dopamine1-receptor agonist, in hypertensive patients. Br J Clin Pharmacol 25:17–21

    PubMed  CAS  Google Scholar 

  41. White WB, Halley SE (1989) Comparative renal effects of intravenous administration of fenoldopam mesylate and sodium nitroprusside in patients with severe hypertension. Arch Intern Med 149:870–874

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Cardiothoracic Anaesthesia and Intensive Care, Università Vita-Salute San Raffaele, Milano, Italia

    G. Landoni MD, D. Poli MD & T. Bove MD

  2. Istituto Scientifico San Raffaele, Milano, Via Olgettina 60, Milano, 20132, Italia

    G. Landoni MD, D. Poli MD & T. Bove MD

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  1. G. Landoni MD
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  2. D. Poli MD
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  3. T. Bove MD
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Correspondence to G. Landoni MD.

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Landoni, G., Poli, D. & Bove, T. Fenoldopamin in cardiac surgery. Clin Res Cardiol Suppl 2 (Suppl 1), S91–S95 (2007). https://doi.org/10.1007/s11789-006-0046-5

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  • DOI: https://doi.org/10.1007/s11789-006-0046-5

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