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CARDIOVASCULAR ANESTHESIA

Fenoldopam Mesylate and Renal Function in Patients Undergoing Liver Transplantation: A Randomized, Controlled Pilot Trial

G. Della Rocca, MD^*, L. Pompei^*, M. G. Costa, MD^*, C. Coccia^*, L. Scudeller, MD, P. Di Marco, MD, S. Monaco, MD, and P. Pietropaoli, MD

*Department of Anesthesia, Medical School of Medicine, University of Udine; Institute of Infectious Diseases, Department of Medical and Morphological Research, University of Udine; and Department of Anesthesia and Intensive Care Unit, University of Rome "La Sapienza," Rome, Italy

Address correspondence and reprint requests to Giorgio Della Rocca, MD, C.so Trieste 169/A., 00198 Rome, Italy. Address e-mail to giorgio.dellarocca{at}uniud.it

To test the relative effects on serum creatinine (CRE), blood urea nitrogen (BUN), and urine output of small-dose dopamine and fenoldopam in patients undergoing liver transplantation, we randomized 43 patients to 1 of 2 continuous infusions over 48 h, starting with anesthesia induction: fenoldopam, 0.1 µg · kg^–1 · min^–1 or dopamine, 2 µg · kg^–1 · min^–1. We used predetermined hemodynamic and intravascular volume goals (intrathoracic blood volume index 800–1000 mL/m², extravascular lung water index <7 mL/kg) to manage patients with an algorithm for use of mannitol and furosemide to maintain urine output >1 mL · kg^–1 · h^–1. At postoperative day 3, the median CRE increase was 0.2 mg/dL (interquartile range [IQR] –0.2–0.5) with fenoldopam and 0.5 mg/dL (IQR 0.3–0.9, P = 0.004) in the dopamine group. The BUN increase was median 2 mg/dL (IQR –2–8) versus 8.5 mg/dL (IQR 5–12, P = 0.01), respectively, with fenoldopam versus dopamine. Urine output was similar; however, significantly fewer fenoldopam patients required furosemide compared with dopamine patients (median 1 [IQR 0–3] versus 3 [IQR 2–4], respectively, P = 0.003). The hemodynamic effects of dopamine and fenoldopam were similar. Compared with dopamine, in the setting of liver transplantation, fenoldopam is associated with better CRE and BUN values.

IMPLICATIONS: We evaluated renal function comparing fenoldopam versus dopamine in liver transplantation recipients. In the fenoldopam-treated group, serum creatinine and BUN improved. There were more "interventions" of furosemide to maintain urine output >1 mL · kg^–1 · h^–1 in the dopamine group.

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