• Agostino Roasio, Rosetta Lobreglio, Agostino Santin, Giovanni Landoni, and Claudio Verdecchia.
• Cardiothoracic Anesthesia and Intensive Care Unit, Azienda Sanitaria Ospedaliera S. Giovanni Battista, Turin, Italy.
• J. Cardiothorac. Vasc. Anesth. 2008 Feb 1;22(1):23-6.

ObjectiveTo investigate whether a continuous 48-hour infusion of fenoldopam, 0.1 mug/kg/min, reduced the need for renal replacement therapy in patients with acute renal injury after cardiac surgery.DesignCase-matched study.SettingTeaching hospital.ParticipantsNinety-two patients.InterventionsPatients who developed acute renal injury (defined as serum creatinine doubling or oliguria) after cardiac surgery received a continuous infusion of fenoldopam, 0.1 mug/kg/min, (46 patients) for 48 hours. They were case matched with 46 patients who developed acute renal injury, had similar baseline characteristics, and received standard treatment (hemodynamic support to obtain a mean arterial pressure >60 mmHg, fluid administration to increase central venous pressure >10 mmHg, and loop diuretics to maintain a urine output >0.5 mL/kg/h). Renal replacement therapy was started when acute renal injury became oligoanuric, when serum creatinine increased >4 mg/dL or 3 times basal value, or in the presence of severe hyperkalemia (K >6.5 mmol/L) or severe acidemia (pH < 7).Measurements And Main ResultsPatients in the fenoldopam group had a reduced need for renal replacement therapy (8 patients, 17%) with respect to case-matched controls (18 patients, 39%; p = 0.037). The length of intensive care unit stay (median [interquartile range]) was similar in the 2 groups: fenoldopam group, 5 days (3-9 days), and control group, 10 days (3-16 days, p = 0.15).ConclusionsGiven the limitations of case-matched studies, fenoldopam may be useful in avoiding renal replacement therapy in patients who develop acute renal injury after cardiac surgery.

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