Perioperative fenoldopam for the prevention of acute renal failure in non-cardiac surgery, randomized clinical trial

Purpose. Acute renal failure is a serious complication of surgery causing morbidity and mortality. The aim of this study was to evaluate the efficacy of fenoldopam, a selective dopamine-1 receptor agonist, in patients at high risk of perioperative renal dysfunction. Methods. In this prospective single-center randomized double-blind trial we enrolled 64 patients undergoing major surgery. Patients received either fenoldopam at a dosage of 0.05 mcg/kg/min or dopamine at a dosage of 2.5 mcg/kg/min after anesthesia induction for a 12-hour period. The primary endpoint was defined as 25% serum creatinine increase from baseline after surgery. Results. All the patients included were at high risk of perioperative renal dysfunction and underwent major surgery. The two groups (fenoldopam versus dopamine) were homogenous cohorts and no difference in outcome was observed. The incidence of acute renal failure was similar: 11/32 (34%) in the fenoldopam group and 14/32 (44%) in the dopamine group (p=0.6). The postoperative serum creatinine peak was also similar in the two groups. No in-hospital death was observed. Conclusion. Despite an increasing number of reports suggesting renal protective properties of fenoldopam, we observed no difference in clinical outcome compared to dopamine in a high-risk population undergoing major surgery.