Fenoldopam and Renal Function After Partial Nephrectomy in a Solitary Kidney: A Randomized, Blinded Trial

Objective To test the hypothesis that fenoldopam administration ameliorates ischemic injury, preserving the glomerular filtration rate and serum creatinine postoperatively after partial nephrectomy in patients with a solitary kidney. Materials and Methods Fenoldopam is a short-acting dopamine-1 rece...

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Published in:	Urology (Ridgewood, N.J.) Vol. 81; no. 2; pp. 340 - 346
Main Authors:	O'Hara, Jerome F, Mahboobi, Ramatia, Novak, Steven M, Bonilla, Angela M, Mascha, Edward J, Fergany, Amr F, Campbell, Steven C, Kaouk, Jihad H, Kaple, Kristina M, Gill, Inderbir S, Ziegman, Stephanie A, Sessler, Daniel I
Format:	Journal Article
Language:	English
Published:	New York, NY Elsevier Inc 01-02-2013 Elsevier
Subjects:	Acute Kidney Injury - physiopathology Acute Kidney Injury - prevention & control Aged Biological and medical sciences Carcinoma, Renal Cell - surgery Creatinine - blood Dopamine Agonists - pharmacology Dopamine Agonists - therapeutic use Double-Blind Method Female Fenoldopam - pharmacology Fenoldopam - therapeutic use Glomerular Filtration Rate - drug effects Humans Kidney Neoplasms - surgery Kidneys Male Malformations of the urinary system Medical sciences Middle Aged Nephrectomy - adverse effects Nephrology. Urinary tract diseases Reperfusion Injury - physiopathology Reperfusion Injury - prevention & control Statistics, Nonparametric Urology Kidney disease Agonist Nephrology Urinary system disease Renal function Vasodilator agent D1 Dopamine receptor Congenital disease Solitary kidney Urology Fenoldopam Diuretic Hypotensive drug Randomization Treatment Nephrectomy Partial Malformation Surgery Dopamine agonist Antihypertensive agent Clinical trial
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Summary:	Objective To test the hypothesis that fenoldopam administration ameliorates ischemic injury, preserving the glomerular filtration rate and serum creatinine postoperatively after partial nephrectomy in patients with a solitary kidney. Materials and Methods Fenoldopam is a short-acting dopamine-1 receptor agonist that might provide renal protection during ischemic stress. A total of 90 patients with a solitary functioning kidney who were undergoing partial nephrectomy were randomized to fenoldopam or placebo in a double-blind protocol. The patients assigned to fenoldopam received an infusion rate of 0.1 μg/kg/min for 24 hours. The effect of fenoldopam on renal function was assessed by comparing the groups on the change in glomerular filtration rate from baseline to the third postoperative day (primary outcome) and on the change in serum creatinine over time (secondary outcome). Results Of the 90 enrolled patients, 77 provided analyzable data (43 in fenoldopam and 44 in placebo group). Fenoldopam (vs placebo) did not reduce the mean percentage of change in the glomerular filtration rate from baseline to the third postoperative day ( P = .15), with an estimated ratio of means of 0.89 (95% confidence interval 0.69-1.09) for fenoldopam vs placebo. The postoperative serum creatinine in the 2 groups changed at comparable rates from postoperative day 1 to 4 (group-by-time interaction, P = .72) after adjusting for baseline creatinine, with no difference in the mean serum creatinine over time ( P = .78). Conclusion Fenoldopam administration did not preserve renal function in the clinical setting of renal ischemia during solitary partial nephrectomy, as evidenced by changes in the glomerular filtration rate or serum creatinine.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-News-1 ObjectType-Feature-3 content type line 23
ISSN:	0090-4295 1527-9995
DOI:	10.1016/j.urology.2012.09.041