| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Ann Thorac Surg 2004;78:1332-1337
© 2004 The Society of Thoracic Surgeons
a Cardiothoracic Anesthesia and Intensive Care, Istituto Policlinico S. Donato, Milan, Italy
b Cardiac Surgery Intensive Care Unit, Azienda Ospedaliera S. Croce and Carle, Cuneo, Italy
c Anesthesia and Intensive Care Unit, Villa Maria Pia Hospital, Turin, Italy
d Anesthesia and Intensive Care I, Ospedali Riuniti, Bergamo, Italy
e Cardiac Anesthesia and Intensive Care, Spedali Civili, Brescia, Italy
f Cardiovascular Intensive Care Unit, Ospedale Mauriziano Umberto I, Turin, Italy
g Cardiovascular Anesthesia and Intensive Care, IRCCS San Raffaele Hospital, Milan, Italy
h Anesthesia and Intensive Care, IRCCS Centro Cardiologico Monzino, Milan, Italy
i Anesthesia and Intensive Care A, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
Accepted for publication February 18, 2004.
* Address reprint requests to Dr Ranucci, Cardiothoracic Anaesthesia Department, Istituto Policlinico S. Donato, Via Morandi 30, 20097 San Donato Milanese, Milan, Italy
cardioanestesia{at}virgilio.it
BACKGROUND: Acute renal failure requiring replacement therapy occurs in 1% to 2% of patients who have undergone cardiac surgery with cardiopulmonary bypass and is associated with a very high mortality rate. The aim of this study was to determine if prophylactic treatment with fenoldopam mesylate of patients at high risk of postoperative acute renal failure reduced the incidence of this event.
METHODS: This was a multicenter, prospective, cohort study in which 108 patients at high risk of postoperative acute renal failure and undergoing cardiac surgery with cardiopulmonary bypass were treated with fenoldopam mesylate (0.08 µg · kg–1 · min–1) starting at the induction of anesthesia and throughout at least the next 24 hours. A homogeneous control group of 108 patients was created using a propensity-score analysis.
RESULTS: Fenoldopam prophylaxis was significantly associated with a reduction in acute renal failure incidence (from 22% to 11%, p = 0.028), a less pronounced creatinine clearance decrease (p = 0.05), and a lower mortality rate (6.5% versus 15.7%, p = 0.03) by the univariate analysis, but these results were not confirmed by a multivariable analysis. Within the subgroup of patients who suffered a postoperative low output syndrome, fenoldopam prophylaxis was an independent protective factor for postoperative renal failure (odds ratio, 0.14; 95% confidence interval, 0.03 to 0.7; p = 0.017).
CONCLUSIONS: Given the limitations of a nonrandomized prospective trial, our results support the hypothesis that fenoldopam may reduce the risk of acute renal failure in patients in whom endogenous and exogenous cathecolamines action may induce a renal vascular constrictive condition.
Related Article
Ann. Thorac. Surg. 2004 78: 1337-1338.
This article has been cited by other articles:
|
|
 |
|
  M. H. Rosner, D. Portilla, and M. D. Okusa Analytic Reviews: Cardiac Surgery as a Cause of Acute Kidney Injury: Pathogenesis and Potential Therapies J Intensive Care Med, January 1, 2008; 23(1): 3 - 18. [Abstract] [PDF]
|
|
|
|
 |
|
 M. Ranucci Perioperative Renal Failure: Hypoperfusion During Cardiopulmonary Bypass? Seminars in Cardiothoracic and Vascular Anesthesia, December 1, 2007; 11(4): 265 - 268. [Abstract] [PDF]
|
|
|
|
 |
|
 M. H. Rosner and M. D. Okusa Acute Kidney Injury Associated with Cardiac Surgery Clin. J. Am. Soc. Nephrol., January 1, 2006; 1(1): 19 - 32. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Ranucci, F. Romitti, G. Isgro, M. Cotza, S. Brozzi, A. Boncilli, and A. Ditta Oxygen Delivery During Cardiopulmonary Bypass and Acute Renal Failure After Coronary Operations Ann. Thorac. Surg., December 1, 2005; 80(6): 2213 - 2220. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. D. Rocca and L. Pompei To Dilate or Not To Dilate Anesth. Analg., October 1, 2005; 101(4): 1242 - 1242. [Full Text] [PDF]
|
|
|
|
 |
|
 K. E. A. Burns, M. W. A. Chu, R. J. Novick, S. A. Fox, K. Gallo, C. M. Martin, L. W. Stitt, A. P. Heidenheim, M. L. Myers, and L. Moist Perioperative N-acetylcysteine to Prevent Renal Dysfunction in High-Risk Patients Undergoing CABG Surgery: A Randomized Controlled Trial JAMA, July 20, 2005; 294(3): 342 - 350. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. L. Mehta Acute Renal Failure and Cardiac Surgery: Marching in Place or Moving Ahead? J. Am. Soc. Nephrol., January 1, 2005; 16(1): 12 - 14. [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
