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Preventing contrast-induced nephropathy with fenoldopam
D W Hunter1, A Chamsuddin, H Bjarnason
1Department of Radiology, MMC 292, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN 55455, USA.
Summary
Fenoldopam, a dopamine variant, acts as a selective DA-1 receptor agonist, enhancing renal blood flow and sodium excretion. This orphan drug shows promise in protecting kidneys from contrast-induced nephropathy in high-risk patients.
Area of Science:
- Pharmacology
- Nephrology
- Cardiovascular Medicine
Background:
- Fenoldopam is a selective dopamine type 1 (DA-1) receptor agonist.
- DA-1 receptors are abundant in renal and peripheral vasculature.
- Fenoldopam induces vasodilation, increases renal blood flow, and promotes natriuresis.
Purpose of the Study:
- To evaluate fenoldopam's potential as a renal protective agent.
- To assess its efficacy in preventing contrast-induced nephropathy in high-risk patients.
Main Methods:
- Intravenous fenoldopam infusion initiated pre-procedure, with dose titration based on blood pressure.
- Administration maintained throughout procedures and post-contrast exposure.
- Anecdotal case series of 29 high-risk patients (diabetes, renal failure) receiving fenoldopam before contrast procedures.
Main Results:
- Fenoldopam demonstrated potent renal protective effects in animal models, being 6 times more effective than dopamine.
- In a small group of high-risk patients, fenoldopam was associated with a lack of contrast-induced creatinine increase.
- The drug's clinical activity is rapid, with no rebound effect, and can be discontinued at any time.
Conclusions:
- Fenoldopam shows promising potential as a renal protective agent, particularly for high-risk patients undergoing procedures requiring intravascular contrast.
- Further investigation through prospective, randomized trials comparing fenoldopam with hydration is warranted to confirm its efficacy.