30 Nov Fenoldopam Does Not Prevent Acute Kidney Injury After Cardiac Surgery

MedicalResearch.com Interview with:
Giovanni Landoni, M.D.
Head of Research,Department of Anesthesiology and Intensive Care
Associate Professor at Università Vita-Salute San Raffaele, Milan

Medical Research: What is the background for this study?

Dr. Landoni: The prevention and treatment of acute kidney injury after cardiac surgery is a major therapeutic goal, but no effective agents have yet been identified. Meta-analyses suggested that fenoldopam might be effective.

Medical Research: What are the main findings?

Dr. Landoni: We found that in cardiac surgery patients with early acute kidney injury (defined as a ≥50% increase of serum creatinine from baseline or oliguria for ≥6 hours), fenoldopam had no impact on the need for renal replacement therapy or 30-day mortality, while increasing the rate of hypotension.

Medical Research: What should clinicians and patients take away from your report?

Dr. Landoni: Fenoldopam is available in Europe and the USA. It was approved by FDA in 1997 and indicated for the in-hospital, short-term management of severe hypertension. Fenoldopam has not gained FDA approval for renal indications although it has been widely used off label in the USA for kidney protection in various settings. Our trial demonstrates that fenoldopam is not effective for the prevention and treatment of AKI in cardiac surgery and, by analogy, suggests that effectiveness might also be absent in other patients with early AKI.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Landoni: The study provides evidence against fenoldopam use as an off-label kidney protection strategy in cardiac surgery, but other settings and other populations of patients with early AKI should be investigated to strengthen this statement. Furthermore, there is a need for a paradigm change in kidney protection after surgery and this study contributes to highlight the need for new strategies and molecules in this field.

 Citation:

Effect of Fenoldopam on Use of Renal Replacement Therapy Among Patients With Acute Kidney Injury After Cardiac Surgery: A Randomized Clinical Trial
Bove T¹, Zangrillo A², Guarracino F³, Alvaro G⁴, Persi B⁵, Maglioni E⁶, Galdieri N⁷, Comis M⁸, Caramelli F⁹, Pasero DC¹⁰, Pala G¹¹, Renzini M¹², Conte M¹³, Paternoster G¹⁴, Martinez B¹⁵, Pinelli F¹⁶, Frontini M¹⁷, Zucchetti MC¹⁸, Pappalardo F¹, Amantea B⁴, Camata A⁵, Pisano A⁷, Verdecchia C⁸, Dal Checco E⁹, Cariello C³, Faita L⁴, Baldassarri R³, Scandroglio AM¹, Saleh O¹, Lembo R¹, Calabrò MG¹, Bellomo R¹⁹, Landoni G².
JAMA. 2014 Sep 29. doi: 10.1001/jama.2014.13573. [Epub ahead of print]

Last Updated on November 30, 2014 by Marie Benz MD FAAD