• Susan Garwood, Cephas P Swamidoss, Elizabeth A Davis, Leah Samson, and Roberta L Hines.
• Department of Anesthesiology, Yale University School of Medicine, New Haven, CT 06520, USA. susan.garwood@yale.edu
• J. Cardiothorac. Vasc. Anesth. 2003 Feb 1;17(1):17-21.

ObjectiveTo evaluate the usefulness of low-dose fenoldopam mesylate in patients at risk of developing renal dysfunction after cardiac surgery requiring cardiopulmonary bypass.DesignA prospective, single-center, observational study.SettingUniversity teaching hospital.ParticipantsSeventy patients scheduled for elective cardiac surgery with one or more predefined risk factors for renal dysfunction.InterventionsAfter induction of anesthesia, fenoldopam (0.03 microg/kg/min) was administered throughout surgery and into the postoperative period, until the patient was stable and weaned from all other vasoactive agents. Perioperatively, fenoldopam was also used as a second-line antihypertensive agent as required.Measurements And Main ResultsNo patient developed renal failure that required dialysis, whereas 7.1% (5/70) developed non-dialysis-dependent renal dysfunction. Four out of these 5 patients had 2 or more risk factors (9.5%). Higher preoperative creatinine levels, a history of hypertension, myocardial infarction within 5 days of surgery, and a preoperative diagnosis of chronic renal insufficiency were all good predictors of postoperative non-dialysis-dependent renal dysfunction. Discharge serum creatinine levels were lower than preoperative levels (1.16 +/- 0.36 mg/dL v 1.26 +/- 0.34 mg/dL, p < 0.05).ConclusionThese findings suggest that renal function was preserved in patients at increased risk for renal dysfunction after cardiac surgery when low-dose fenoldopam was used in the perioperative period. However, a randomized, controlled trial is required to establish efficacy.Copyright 2003, Elsevier Science (USA). All rights reserved.

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