Abstract
BackgroundFenoldopam is a short-acting dopamine A1 receptor agonist which mediates vasodilation of the renal arteries, thereby increasing urine output. The objective of this study was to compare the effects of fenoldopam and its synergistic effect on furosemide for improving the urine output in postoperative critically ill patients with acute kidney injury (AKI).MethodsThis is a retrospective study of postoperative critically ill patients with AKI. Patients who received furosemide (control group) were compared with those who received furosemide plus fenoldopam (treatment group) and evaluated at 12 and 24 hours post-treatment. Patients with oliguria and AKI were included in the study, while patients with chronic kidney disease (CKD) were excluded. Glomerular filtration rate, serum creatinine, blood pressure, calculated fluid accumulation, fluid intake, urine output, and total fluid output were used as variables to assess the medication effect.ResultsOf the 126 patients who met the inclusion and exclusion criteria, 87 patients received furosemide alone, and 39 patients received furosemide plus fenoldopam during their first 24 hours of admission to the surgical intensive care unit (SICU). Although not statistically significant, the addition of fenoldopam demonstrated an increase in mean urine output of 1525ml (IQR; 1530-2095) in the first 24 hours (P=0.06). There was also noted an increase in the urine output (p= 0.07) and a decrease in the total fluid accumulation when fenoldopam was co-administered with furosemide when compared to the patients who were only treated with furosemide (p=0.06). There was no significant change in creatinine clearance from baseline in either group. ConclusionFenoldopam may increase urine output in postoperative critically ill patients with acute kidney injury when administered within the first 24 hours of presentation. Based on our results, fenoldopam appears to have a synergistic effect with furosemide in our study population.
Highlights
Postoperative patients tend to receive a significant amount of fluid in order to maintain hemodynamic stability
Patients with oliguria and acute kidney injury (AKI) were included in the study, while patients with chronic kidney disease (CKD) were excluded
The addition of fenoldopam demonstrated an increase in mean urine output of 1525ml (IQR; 1530-2095) in the first 24 hours (P=0.06)
Summary
Postoperative patients tend to receive a significant amount of fluid in order to maintain hemodynamic stability. Patients with fluid accumulation and acute kidney injury (AKI) have a higher mortality, with previous studies showing a 60-day mortality rate of 36% compared to 16% when fluid accumulation is not an issue [2,3]. Since the unified use of Risk, Injury, Failure, Loss, and End-stage (RIFLE) criteria from the Acute Dialysis Quality Initiative of 2004, the overall incidence range of AKI has increased to 20% to 50%. In 2012 the Kidney Disease Improving Global Outcomes (KDIGO) released their clinical practice guidelines for acute kidney injury (AKI), which build off of the RIFLE criteria. The objective of this study was to compare the effects of fenoldopam and its synergistic effect on furosemide for improving the urine output in postoperative critically ill patients with acute kidney injury (AKI)
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