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Fenoldopam missed renal endpoint, caused hypotension in cardiac surgery patients

Key clinical point: Fenoldopam did not lessen early kidney injury after cardiac surgery and caused hypotension.

Major finding: Fenoldopam did not reduce the rate of dialysis or 30-day mortality after cardiac surgery, and 26% of treated patients developed hypotension compared with 15% of the placebo group (P = .001).

Data source: Randomized, double-blind, multicenter trial of 667 patients with early acute kidney injury after cardiac surgery.

Disclosures: The Italian Ministry of Health funded the study. Teva supplied the study drug. The authors reported no conflicts of interest.


 

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In its largest randomized controlled trial to date, fenoldopam did not lessen the need for dialysis after cardiac surgery and caused significantly more hypotension than did placebo, investigators reported at the annual congress of the European Society of Intensive Care Medicine.

Acute kidney injury is a common complication of cardiac surgery, and no drugs are known to effectively treat it, said Dr. Tiziana Bove of IRCCS San Raffaele Scientific Institute in Milan. “Given the cost of fenoldopam, the lack of effectiveness, and the increased incidence of hypotension, the use of this agent for renal protection in these patients is not justified,” said Dr. Bove and her associates.

The findings were published in JAMA simultaneously with the presentation at the congress ( 2014 Sept 29 [doi: 10.1001/jama.2014.13573]).

Fenoldopam is a selective dopamine receptor D1 agonist and vasodilator. For the study, 667 patients who had developed early acute kidney injury after cardiac surgery received either an intravenous continuous infusion of fenoldopam at a starting dose of 0.1 mcg/kg per minute or placebo, the investigators said. Rates of dialysis and 30-day mortality were similar between the two groups. In all, 20% of the treatment group received renal replacement therapy, compared with 18% of the placebo group, and 30-day mortality rates were 23% and 22%, respectively, they said. Furthermore, hypotension developed in 26% of treated patients, compared with 15% of the placebo group (P = .001), the researchers said. The study was stopped for futility after an interim analysis, the researchers noted.The Italian Ministry of Health funded the study. Teva supplied the study drug. The authors reported no conflicts of interest.

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