Document Detail


Prophylactic fenoldopam for renal protection in sepsis: a randomized, double-blind, placebo-controlled pilot trial.
MedLine Citation:
PMID:  16276165     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Acute renal failure is common in septic patients. Fenoldopam, a dopamine-1 receptor agonist, increases renal blood flow and may, therefore, reduce the risk of acute renal failure in such patients. Accordingly, we sought to determine the safety and efficacy of fenoldopam for the prevention of acute renal failure in septic patients. DESIGN: Prospective, double-blind, placebo-controlled trial. SETTING: Three multidisciplinary intensive care units at a university hospital. PATIENTS: Three hundred septic patients with baseline serum creatinine concentrations <150 micromol/L. INTERVENTIONS: We randomized patients to a continuous infusion of either fenoldopam (n = 150) at 0.09 microg x kg x min or placebo (n = 150) while in the intensive care unit. The primary outcome measure was the incidence of acute renal failure, defined as a serum creatinine concentration increase to >150 micromol/L, during study drug infusion. MEASUREMENTS AND MAIN RESULTS: The incidence of acute renal failure was significantly lower in the fenoldopam group compared with the control group (29 vs. 51 patients; p = .006). The odds ratio of developing acute renal failure for patients treated with fenoldopam was estimated to be 0.47 (p = .005). The difference in the incidence of severe acute renal failure (creatinine >300 mumol/L), however, failed to achieve statistical significance (10 vs. 21; p = .056). The length of intensive care unit stay in surviving patients was significantly lower in the fenoldopam group compared with the control group (10.64 +/- 9.3 vs. 13.4 +/- 14.0; p < .001). There were no complications of fenoldopam infusion. A direct effect of treatment on the probability of death, beyond its effect on acute renal failure, was not significant (odds ratio = 0.68, p = .1). CONCLUSIONS: Compared with placebo, low-dose fenoldopam resulted in a smaller increase in serum creatinine in septic patients. The clinical significance of this finding is uncertain. A large multiple-center trial is now needed to confirm these findings.
Authors:
Andrea Morelli; Zaccaria Ricci; Rinaldo Bellomo; Claudio Ronco; Monica Rocco; Giorgio Conti; Andrea De Gaetano; Umberto Picchini; Alessandra Orecchioni; Monica Portieri; Flaminia Coluzzi; Patrizia Porzi; Paola Serio; Annunziata Bruno; Paolo Pietropaoli
Related Documents :
9864665 - Evaluation of urinary markers in acute renal failure.
3480085 - Xanthine lithiasis, nephrocalcinosis, and renal failure in a leukemia patient treated w...
19371555 - Considerations in the diagnosis and therapy for acute loin pain.
8315495 - Renal scintigraphy in acute scleroderma: report of three cases.
17510095 - Time-dependent changes in cardiac growth after kidney transplantation: the impact of pr...
10708165 - Factors predicting perioperative cytokine response in patients undergoing liver transpl...
Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Critical care medicine     Volume:  33     ISSN:  0090-3493     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2005 Nov 
Date Detail:
Created Date:  2005-11-08     Completed Date:  2005-12-06     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2451-6     Citation Subset:  AIM; IM    
Affiliation:
Department of Anesthesiology and Intensive Care, University of Rome La Sapienza, Rome, Italy.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Creatinine / blood
Dopamine Agonists / therapeutic use*
Double-Blind Method
Female
Fenoldopam / therapeutic use*
Humans
Intensive Care Units
Kidney Failure, Acute / etiology,  prevention & control*
Male
Middle Aged
Sepsis / complications
Chemical
Reg. No./Substance:
0/Dopamine Agonists; 60-27-5/Creatinine; 67227-56-9/Fenoldopam
Comments/Corrections
Comment In:
Crit Care Med. 2005 Nov;33(11):2681-3   [PMID:  16276198 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  Pre-ejection period variations predict the fluid responsiveness of septic ventilated patients.
Next Document:  Low-dose hydrocortisone improves shock reversal and reduces cytokine levels in early hyperdynamic se...