Fenoldopam and acute renal failure in cardiac surgery: a meta-analysis of randomized placebo-controlled trials.

Abstract

OBJECTIVE:

Because at present no pharmacologic prevention or treatment of acute kidney injury seems to be available, the authors updated a meta-analysis to investigate the effects of fenoldopam in reducing acute kidney injury in patients undergoing cardiac surgery, focusing on randomized placebo-controlled studies only.

DESIGN:

A meta-analysis of randomized, placebo-controlled trials.

SETTING:

Hospitals.

PARTICIPANTS:

A total of 440 patients from 6 studies were included in the analysis.

INTERVENTIONS:

None. The ability of fenoldopam to reduce acute kidney injury in the perioperative period when compared with placebo was investigated.

MEASUREMENTS AND MAIN RESULTS:

Google Scholar and PubMed were searched (updated January 1, 2012). Authors and external experts were contacted. Pooled estimates showed that fenoldopam consistently and significantly reduced the risk of acute kidney injury (odds ratio [OR] = 0.41; 95% confidence interval [CI], 0.23-0.74; p = 0.003), with a higher rate of hypotensive episodes and/or use of vasopressors (30/109 [27.5%] v 21/112 [18.8%]; OR = 2.09; 95% CI, 0.98-4.47; p = 0.06) and no effect on renal replacement therapy, survival, and length of intensive care unit or hospital stay.

CONCLUSIONS:

This analysis suggests that fenoldopam reduces acute kidney injury in patients undergoing cardiac surgery. Because the number of the enrolled patients was small and there was no effect on renal replacement therapy or survival, a large, multicenter, and appropriately powered trial is needed to confirm these promising results.

• Authors: Alberto Zangrillo, Giuseppe G L Biondi-Zoccai, Elena Frati, Remo Daniel Covello, Luca Cabrini, Fabio Guarracino, Laura Ruggeri, Tiziana Bove, Elena Bignami, Giovanni Landoni
• Journal: Journal of cardiothoracic and vascular anesthesia (J Cardiothorac Vasc Anesth) Vol. 26 Issue 3 Pg. 407-13 (Jun 2012) ISSN: 1532-8422 [Electronic] United States
• PMID: 22459931 (Publication Type: Journal Article, Meta-Analysis)
• Copyright: Copyright © 2012 Elsevier Inc. All rights reserved.

Chemical References

• Vasodilator Agents
• Fenoldopam

Topics

• Acute Kidney Injury (drug therapy, etiology)
• Cardiac Surgical Procedures (adverse effects)
• Fenoldopam (therapeutic use)
• Humans
• Randomized Controlled Trials as Topic
• Renal Replacement Therapy
• Vasodilator Agents (therapeutic use)