Linda F Barr1, Kenneth Kolodner. 1. Johns Hopkins Medical Institutions, Division of Pulmonary and Critical Care Medicine, Baltimore, MD, USA. lindafbarr@yahoo.com
Abstract
OBJECTIVE: To determine whether fenoldopam and N-acetylcysteine prevent renal deterioration and improve hospital outcome for patients with chronic renal insufficiency undergoing cardiac surgery. DESIGN: Prospective, randomized, double-blinded, placebo-controlled trial. SETTING: A community hospital that is a cardiac referral center. PATIENTS: Seventy-nine adult patients with chronic renal insufficiency (creatinine clearance < or = 40 mL/min) who underwent cardiac surgery. INTERVENTIONS: Group 1 received intravenous fenoldopam 0.1 microg/kg/min started at surgical induction and continued for 48 hrs. Group 2 received N-acetylcysteine 600 mg orally twice a day, from preoperative day 1 to postoperative day 1. Group 3 received both fenoldopam and N-acetylcysteine, and group 4 patients served as controls. MEASUREMENTS AND MAIN RESULTS: Using multiple comparisons (analysis of variance) with change scores, and statistically adjusting for group differences in aortic cross-clamp time, use of intraoperative aprotinin, and preoperative use of statin, we found that the change in creatinine clearance from preoperative to postoperative day 3 was statistically less for group 1 (-1.47 mL/min +/- 2.06 SE, p = .0286) and for group 2 (-0.67 mL/min +/- 2.11 SE, p = .0198) and less but not quite significant for group 3 (-3.08 mL/min +/- 1.95 SE, p = .0891) compared with controls (-8.15 mL/min +/- 2.18 SE). Furthermore, the adjusted weight gain on postoperative day 3 was 5.55 kg +/- 1.00 SE (p = .0988) for group 1, 5.06 kg +/- 1.06 SE (p = .0631) for group 2, and 5.14 kg +/- .91 SE (p = .0445) for group 3 compared with 8.03 kg +/- 1.07 SE for group 4. However, there was no decrease in length of critical care or hospital stay or hospital costs. Finally, fenoldopam contributed to perioperative hypotension. CONCLUSIONS:Perioperative fenoldopam and N-acetylcysteine abrogate the early postoperative decline in renal function of patients who have chronic renal insufficiency, although these agents do not affect other parameters of cardiac surgical outcome.
RCT Entities:
OBJECTIVE: To determine whether fenoldopam and N-acetylcysteine prevent renal deterioration and improve hospital outcome for patients with chronic renal insufficiency undergoing cardiac surgery. DESIGN: Prospective, randomized, double-blinded, placebo-controlled trial. SETTING: A community hospital that is a cardiac referral center. PATIENTS: Seventy-nine adult patients with chronic renal insufficiency (creatinine clearance < or = 40 mL/min) who underwent cardiac surgery. INTERVENTIONS: Group 1 received intravenous fenoldopam 0.1 microg/kg/min started at surgical induction and continued for 48 hrs. Group 2 received N-acetylcysteine 600 mg orally twice a day, from preoperative day 1 to postoperative day 1. Group 3 received both fenoldopam and N-acetylcysteine, and group 4 patients served as controls. MEASUREMENTS AND MAIN RESULTS: Using multiple comparisons (analysis of variance) with change scores, and statistically adjusting for group differences in aortic cross-clamp time, use of intraoperative aprotinin, and preoperative use of statin, we found that the change in creatinine clearance from preoperative to postoperative day 3 was statistically less for group 1 (-1.47 mL/min +/- 2.06 SE, p = .0286) and for group 2 (-0.67 mL/min +/- 2.11 SE, p = .0198) and less but not quite significant for group 3 (-3.08 mL/min +/- 1.95 SE, p = .0891) compared with controls (-8.15 mL/min +/- 2.18 SE). Furthermore, the adjusted weight gain on postoperative day 3 was 5.55 kg +/- 1.00 SE (p = .0988) for group 1, 5.06 kg +/- 1.06 SE (p = .0631) for group 2, and 5.14 kg +/- .91 SE (p = .0445) for group 3 compared with 8.03 kg +/- 1.07 SE for group 4. However, there was no decrease in length of critical care or hospital stay or hospital costs. Finally, fenoldopam contributed to perioperative hypotension. CONCLUSIONS: Perioperative fenoldopam and N-acetylcysteine abrogate the early postoperative decline in renal function of patients who have chronic renal insufficiency, although these agents do not affect other parameters of cardiac surgical outcome.
Authors: Meyeon Park; Steven G Coca; Sagar U Nigwekar; Amit X Garg; Susan Garwood; Chirag R Parikh Journal: Am J Nephrol Date: 2010-04-06 Impact factor: 3.754
Authors: Mathew Zacharias; Mohan Mugawar; G Peter Herbison; Robert J Walker; Karen Hovhannisyan; Pal Sivalingam; Niamh P Conlon Journal: Cochrane Database Syst Rev Date: 2013-09-11
Authors: G Landoni; T Bove; D Pasero; M Comis; S Orando; F Pinelli; F Guarracino; A Corcione; N Galdieri; M Zucchetti; E Maglioni; B Biagioli; G Pala; M Frontini; F Caramelli; B Persi; M Renzini; F Paoletti; L Lorini; A Morelli; G Alvaro; R Bianco; D Pittarello; A Manzato; G Pedersini; A Mizzi; N Lojacono; P Leoncini; T Iovino; C Cariello; R Baldassarri; A M Camata; G Padua; G Frascaroli; S Leonardi; E Bignami; A Zangrillo Journal: HSR Proc Intensive Care Cardiovasc Anesth Date: 2010