Differential Effects Between Intravenous and Targeted Renal Delivery of Fenoldopam on Renal Function and Blood Pressure in Patients Undergoing Cardiac Catheterization

• Published in: The American journal of cardiology Vol. 97; no. 7; pp. 1076 - 1081
• Main Authors: Teirstein, Paul S., Price, Matthew J., Mathur, Vandana S., Madyoon, Hooman, Sawhney, Neil, Baim, Donald S.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-04-2006; Elsevier; Elsevier Limited
• Subjects: Aged; Biological and medical sciences; Blood Pressure - drug effects; Blood tests; Cardiac Catheterization; Cardiology; Cardiology. Vascular system; Clinical trials; Cross-Over Studies; Delivery. Postpartum. Lactation; Drug Delivery Systems; Drug therapy; Female; Fenoldopam - administration & dosage; Fenoldopam - pharmacology; Glomerular Filtration Rate - drug effects; Gynecology. Andrology. Obstetrics; Humans; Hypertension; Infusions, Intra-Arterial; Infusions, Intravenous; Kidney diseases; Male; Medical imaging; Medical research; Medical sciences; Pilot Projects; Renal Insufficiency, Chronic - physiopathology; Renal Insufficiency, Chronic - prevention & control; Vasodilator Agents - administration & dosage; Vasodilator Agents - pharmacology; Heart; Human; Kidney disease; Urinary system disease; Renal function; Intravenous administration; Catheterization; Patient; Phlebology; Fenoldopam; Target; Arterial pressure; Blood pressure; Circulatory system; Cardiology
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2005.10.053

A randomized, controlled clinical trial demonstrated that intravenous (IV) fenoldopam did not prevent further deterioration in renal function after contrast administration in patients with chronic renal insufficiency. This lack of effect may have been a consequence of the inability to administer an effective renal dose of IV fenoldopam. This study sought to determine whether compared with IV administration, selective intrarenal (IR) fenoldopam would increase local concentration, leading to a higher glomerular filtration rate (GFR), and, because of first-pass renal elimination, result in lower systemic drug levels and less decrease in systemic blood pressure (BP). A randomized, controlled, open-label, partial crossover design trial was conducted in which 33 patients who underwent coronary angiography were randomized in a 1:2 ratio to control or fenoldopam (initially IV, then crossed over to IR through a bifurcated renal infusion catheter). Compared with IV fenoldopam, IR administration was associated with a significantly higher GFR (73.7 ± 3.1 vs 62.6 ± 2.5 ml/min, p = 0.0007) and renal plasma flow (537.2 ± 34.0 vs 494.0 ± 35.5 ml/min, p <0.01), lower fenoldopam plasma levels (3.3 ± 0.3 vs 4.8 ± 0.3 ng/ml, p <0.0001), and greater nadir systolic BP (125.5 ± 3.6 vs 117.4 ± 2.8 mm Hg, p <0.0001). Two hours after drug discontinuation after contrast administration, GFRs in the patients who received IR fenoldopam remained higher than in controls (+15.0 ml/min [+25%] vs −8.0 ml/min [−14.0%], p <0.05). In conclusion, this pilot trial demonstrates that the IR infusion of fenoldopam is safe and practical, producing greater renal effect and less reduction of BP than IV infusion. It would be appropriate to restudy this renal vasodilator for the prevention of contrast nephropathy, using selective IR delivery.