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Original Articles: Adult Cardiac

The Effect of Various Fenoldopam Doses on Renal Perfusion in Patients Undergoing Cardiac Surgery

Cardiac Surgery and Anesthesia and Intensive Care Department, Sant'Ambrogio Hospital, Milan, and Centro Malan, IRCCS San Donato Hospital, San Donato Milanese, Italy

Accepted for publication September 29, 2009.

^_* Address correspondence to Dr Meco, Cardiac Surgery and Anesthesia and Intensive Care Department, Istituto Clinico Sant'Ambrogio, Via Faravelli 16, Milano, 20171, Italy (Email: massimo.meco{at}virgilio.it).

Background: The hypothesis that fenoldopam mesylate, by increasing renal flow, could reduce renal damage in patients undergoing cardiac surgery with cardiopulmonary bypass has gained great interest. The aim of the current study was to quantify the relationship of the increase of the renal blood flow as a function of the fenoldopam dose in these patients and to evaluate renal flow distribution within the renal parenchyma using Doppler.

Methods: Twenty-five patients admitted to cardiac surgery have been enrolled. We used the Doppler technique to measure renal blood flow at the level of the renal, segmental, interlobar, and interlobular arteries. We calculated both the resistive and pulsatility indexes in all the renal segments. Moreover, we calculated echographically all the variables of preload, afterload, and cardiac index. Measurements were performed at baseline and after the infusion of fenoldopam mesylate at the doses of 0.05, 0.1, 0.2, and 0.3 µg · kg^–1 · min^–1.

Results: Fenoldopam infusion at doses more than 0.1 µg · kg^–1 · min^–1 significantly increases blood flow in all renal compartments, thus improving the resistive and pulsatility indexes starting at a dose of 0.1 µg · kg^–1 · min^–1. The highest renal flow increase is observed with 0.3 µg · kg^–1 · min^–1. Fenoldopam seems to increase the renal flow directed to the most external kidney areas. Systemic hemodynamically significant changes are observed only in patients receiving doses more than 0.1 µg · kg^–1 · min^–1.

Conclusions: In hemodynamically stable patients undergoing cardiac surgery with preserved renal function, fenoldopam shows a pharmacodynamic dose-dependent profile: it significantly increases renal flow and reduces the resistances of the renal circulation starting at a dose of 0.1 µg · kg^–1 · min^–1.

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Invited Commentary

Marco Ranucci
Ann. Thorac. Surg. 2010 89: 503-504. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

				M. Meco and S. Cirri Reply Ann. Thorac. Surg., September 1, 2010; 90(3): 1061 - 1061. [Full Text] [PDF]

				G. Lema Fenoldopam, Renal Hemodynamic, and Cardiac Surgery Ann. Thorac. Surg., September 1, 2010; 90(3): 1060 - 1061. [Full Text] [PDF]

				M. Ranucci Invited Commentary Ann. Thorac. Surg., February 1, 2010; 89(2): 503 - 504. [Full Text] [PDF]