Monday, September 29, 2014

IN the NEWS: End of Fenoldopam in prevention of AKI following CT surgery

Fenoldopam has been advocated in prior studies to prevent AKI following surgery: specially studied the most in cardiac surgery.  The most recent issue of JAMA gives us the first randomized multi center placebo controlled trial on use of fenoldopam in CT surgery patients for prevention of AKI. 

Key points:
This study assigned >600 patients to placebo or fenoldopam that were admitted to CT ICU following cardiac surgery with early AKI.  30 day follow up was done.
The primary outcome was need for RRT and mortality was the secondary outcome/ rate of hypotension during infusion.
Patient characteristics appeared equal. There seemed to be more patients with A fib in treatment arm, more pulm HTN and MI in control arm.
Types of surgeries were equal in both( CABG, MVR, AVR, TVR, aorta surgery, and others)
CKD stages based patients were equal in both.  There was 13 CKD IV patients in control  and 19 CKD IV patients in fenoldopam arm.  But majority of them initially had GFR >90. 
Conclusions: Among patients with AKI after CT surgery, fenoldopam infusion compared to placebo showed no benefit in need for RRT or 30 day mortality.
In addition, the infusion caused some harm and led to hypotension episodes compared to placebo arm. 

A prior study had shown similar findings from AJKD.

Is this the end of fenoldopam in prevention of AKI in CT surgery?  Largest study, multi centered and good power showing harm more than benefit. I think we have our answer.  

Full article

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