Effect of fenoldopam on use of renal replacement therapy among patients with acute kidney injury after cardiac surgery

Acute kidney injury (AKI) is a common complication of cardiac surgery and is associated with markedly increased risk of death. AKI occurring after cardiac surgery is likely mediated by ischemic injury, and numerous studies in animal models have suggested that reducing kidney ischemia by administration of vasodilators such as fenoldopam reduces the severity of renal injury. Fenoldopam is a selective dopamine receptor-1 (D1) agonist and induces vasodilation of renal arteries. 

This important study is the largest randomized trial to test the efficacy of fenoldopam in reducing the severity of postoperative AKI and is less likely to have been affected by bias than previous studies. Despite the fact that fenoldopam is not FDA approved for AKI prevention or treatment, many centers administer it for this indication. These data strongly suggest that fenoldopam should not be routinely administered to reduce severity of AKI and that additional studies are needed to identify better strategies to improve clinical outcomes in this at-risk population.