Effects of fenoldopam on renal blood flow in hypertensive chronic kidney disease.
Aged
Antihypertensive Agents
/ administration & dosage
Arterial Pressure
/ drug effects
Blood Flow Velocity
Female
Fenoldopam
/ administration & dosage
Humans
Hypertension
/ complications
Infusions, Intravenous
Italy
Longitudinal Studies
Male
Middle Aged
Renal Artery
/ diagnostic imaging
Renal Circulation
/ drug effects
Renal Insufficiency, Chronic
/ diagnostic imaging
Time Factors
Treatment Outcome
Ultrasonography, Doppler, Color
Vasodilator Agents
/ administration & dosage
Arterial hypertension
Chronic kidney disease
Fenoldopam mesylate
Renal blood flow
Renal resistive index
Journal
Journal of nephrology
ISSN: 1724-6059
Titre abrégé: J Nephrol
Pays: Italy
ID NLM: 9012268
Informations de publication
Date de publication:
Feb 2019
Feb 2019
Historique:
received:
30
01
2018
accepted:
06
04
2018
pubmed:
17
5
2018
medline:
6
5
2020
entrez:
17
5
2018
Statut:
ppublish
Résumé
The synthetic drug fenoldopam mesylate (FM) may have a renoprotective role, and a "renal dose" of 0.1 µg/kg/min intravenous (IV) infusion of FM has been reported as able to increase renal blood flow without affecting systemic blood pressure. But conclusive data are still lacking. We aimed to investigate by color-Doppler ultrasonography the effects of IV administration of FM at this dosage in hypertensive chronic kidney disease (CKD) patients, and verify whether it may induce any systemic hemodynamic alteration. In 60 hypertensive CKD patients, we measured by duplex Doppler ultrasonography, at baseline and during infusion of 0.1 µg/kg/min of FM, the systolic and diastolic flow velocity (sampled at the renal hilum, intermediate section and origin of both renal arteries) and the intra-parenchymal renal resistive index (RRI) sampled on interlobular arteries of both kidneys. Patients were divided into four subgroups (I-IV) according to classification of National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF-DOQI). Infusion of 0.1 µg/kg/min FM significantly decreased the RRI (0.73 ± 0.05 vs. 0.65 ± 0.06; p < 0.0001) and increased the systolic and diastolic flow velocities in all renal artery tracts examined. No single episode of systemic hypotension was observed. Very low-dose FM may significantly increase renal blood flow and exert a renal protective effect in hypertensive CKD patients. Infusion of FM at such low dosage appears also to be quite safe, even in CKD and hypertensive patients.
Sections du résumé
BACKGROUND AND AIM
OBJECTIVE
The synthetic drug fenoldopam mesylate (FM) may have a renoprotective role, and a "renal dose" of 0.1 µg/kg/min intravenous (IV) infusion of FM has been reported as able to increase renal blood flow without affecting systemic blood pressure. But conclusive data are still lacking. We aimed to investigate by color-Doppler ultrasonography the effects of IV administration of FM at this dosage in hypertensive chronic kidney disease (CKD) patients, and verify whether it may induce any systemic hemodynamic alteration.
METHODS
METHODS
In 60 hypertensive CKD patients, we measured by duplex Doppler ultrasonography, at baseline and during infusion of 0.1 µg/kg/min of FM, the systolic and diastolic flow velocity (sampled at the renal hilum, intermediate section and origin of both renal arteries) and the intra-parenchymal renal resistive index (RRI) sampled on interlobular arteries of both kidneys. Patients were divided into four subgroups (I-IV) according to classification of National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF-DOQI).
RESULTS
RESULTS
Infusion of 0.1 µg/kg/min FM significantly decreased the RRI (0.73 ± 0.05 vs. 0.65 ± 0.06; p < 0.0001) and increased the systolic and diastolic flow velocities in all renal artery tracts examined. No single episode of systemic hypotension was observed.
CONCLUSIONS
CONCLUSIONS
Very low-dose FM may significantly increase renal blood flow and exert a renal protective effect in hypertensive CKD patients. Infusion of FM at such low dosage appears also to be quite safe, even in CKD and hypertensive patients.
Identifiants
pubmed: 29766465
doi: 10.1007/s40620-018-0496-0
pii: 10.1007/s40620-018-0496-0
doi:
Substances chimiques
Antihypertensive Agents
0
Vasodilator Agents
0
Fenoldopam
INU8H2KAWG
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
75-81Références
Taylor AA, Shepherd AM, Polvino W, Mangoo-Karim R, Ballard K, Sunthornyothin S, Luther RR, Pool JL (1999) Prolonged fenoldopam infusions in patients with mild to moderate hypertension: pharmacodynamic and pharmacokinetic effects. Am J Hypertens 12(9 Pt 1):906–914
doi: 10.1016/S0895-7061(99)00068-0
pubmed: 10509549
Ziemniak JA, Boppana VK, Cyronak MJ, Stote RM (1989) A retrospective analysis of fenoldopam renal excretion in 65 subjects: evidence for possible intrarenal formation of fenoldopam from its metabolites. Pharm Res 6(8):702–705
doi: 10.1023/A:1015990506743
pubmed: 2573048
Weber RR, McCoy CE, Ziemniak JA, Frederickson ED, Goldberg LI, Murphy MB (1988) Pharmacokinetic and pharmacodynamic properties of intravenous fenoldopam, a dopamine1-receptor agonist, in hypertensive patients. Br J Clin Pharmacol 25(1):17–21
doi: 10.1111/j.1365-2125.1988.tb03276.x
pubmed: 2897206
pmcid: 1386609
Goldberg LI (1984) Dopamine receptors and hypertension. Physiologic and pharmacologic implications. Am J Med 77(4A):37–44
doi: 10.1016/S0002-9343(84)80036-4
pubmed: 6148892
Meco M, Cirri S (2010) Effects of fenoldopam mesylate on central hemodynamics and renal flow in patients undergoing cardiac surgery: color Doppler echocardiographic evaluation. J Cardiothorac Vasc Anesth 24(1):58–62. https://doi.org/10.1053/j.jvca.2009.04.012
doi: 10.1053/j.jvca.2009.04.012
pubmed: 19553140
Kien ND, Moore PG, Jaffe RS (1992) Cardiovascular function during induced hypotension by fenoldopam or sodium nitroprusside in anesthetized dogs. Anesth Analg 74(1):72–78
doi: 10.1213/00000539-199201000-00013
pubmed: 1346487
Inker LA, Astor BC, Fox CH, Isakova T, Lash JP, Peralta CA, Kurella Tamura M, Feldman HI (2014) KDOQI US commentary on the 2012 KDIGO clinical practice guideline for the evaluation and management of CKD. Am J Kidney Dis 63(5):713–735. https://doi.org/10.1053/j.ajkd.2014.01.416
doi: 10.1053/j.ajkd.2014.01.416
pubmed: 24647050
Li G, Xu J, Wang P, Velazquez H, Li Y, Wu Y, Desir GV (2008) Catecholamines regulate the activity, secretion, and synthesis of renalase. Circulation 117(10):1277–1282. https://doi.org/10.1161/CIRCULATIONAHA.107.732032
doi: 10.1161/CIRCULATIONAHA.107.732032
pubmed: 18299506
Gill RW (1985) Measurement of blood flow by ultrasound: accuracy and sources of error. Ultrasound Med Biol 11(4):625–641
doi: 10.1016/0301-5629(85)90035-3
pubmed: 2931884
Stavros AT, Parker SH, Yakes WF, Chantelois AE, Burke BJ, Meyers PR, Schenck JJ (1992) Segmental stenosis of the renal artery: pattern recognition of tardus and parvus abnormalities with duplex sonography. Radiology 184(2):487–492. https://doi.org/10.1148/radiology.184.2.1620853
doi: 10.1148/radiology.184.2.1620853
pubmed: 1620853
Pastore A, De Angelis S, Casciani S, Ruggia R, Di Giovamberardino G, Noce A, Splendiani G, Cortese C, Federici G, Dessi M (2006) Effects of folic acid before and after vitamin B12 on plasma homocysteine concentrations in hemodialysis patients with known MTHFR genotypes. Clin Chem 52(1):145–148. https://doi.org/10.1373/clinchem.2005.056119
doi: 10.1373/clinchem.2005.056119
pubmed: 16391331
Lohman TG, Roche AF, Martorell R (1988) Anthropometric standardization reference manual. Human Kinetics Books, Champaign
Dessi M, Noce A, Agnoli A, De Angelis S, Fuiano L, Tozzo C, Taccone-Gallucci M, Fuiano G, Federici G (2009) The usefulness of the prognostic inflammatory and nutritional index (PINI) in a haemodialysis population. Nutr Metab Cardiovasc Dis 19(11):811–815. https://doi.org/10.1016/j.numecd.2009.01.009
doi: 10.1016/j.numecd.2009.01.009
pubmed: 19361965
Matsushita K, Selvin E, Bash LD, Astor BC, Coresh J (2010) Risk implications of the new CKD Epidemiology Collaboration (CKD-EPI) equation compared with the MDRD Study equation for estimated GFR: the Atherosclerosis Risk in Communities (ARIC) Study. Am J Kidney Dis 55(4):648–659. https://doi.org/10.1053/j.ajkd.2009.12.016
doi: 10.1053/j.ajkd.2009.12.016
pubmed: 20189275
pmcid: 2858455
Meco M, Cirri S (2010) The effect of various fenoldopam doses on renal perfusion in patients undergoing cardiac surgery. Ann Thorac Surg 89(2):497–503. https://doi.org/10.1016/j.athoracsur.2009.09.071
doi: 10.1016/j.athoracsur.2009.09.071
pubmed: 20103330
Mathur VS, Swan SK, Lambrecht LJ, Anjum S, Fellmann J, McGuire D, Epstein M, Luther RR (1999) The effects of fenoldopam, a selective dopamine receptor agonist, on systemic and renal hemodynamics in normotensive subjects. Crit Care Med 27(9):1832–1837
doi: 10.1097/00003246-199909000-00021
pubmed: 10507606
Kim SH, Kim WH, Choi BI, Kim CW (1992) Duplex Doppler US in patients with medical renal disease: resistive index vs. serum creatinine level. Clin Radiol 45(2):85–87
doi: 10.1016/S0009-9260(05)80060-1
pubmed: 1737434
Hanamura K, Tojo A, Kinugasa S, Asaba K, Fujita T (2012) The resistive index is a marker of renal function, pathology, prognosis, and responsiveness to steroid therapy in chronic kidney disease patients. Int J Nephrol 2012:139565. https://doi.org/10.1155/2012/139565
doi: 10.1155/2012/139565
pubmed: 23304501
pmcid: 3533455
Radermacher J, Chavan A, Bleck J, Vitzthum A, Stoess B, Gebel MJ, Galanski M, Koch KM, Haller H (2001) Use of Doppler ultrasonography to predict the outcome of therapy for renal-artery stenosis. N Engl J Med 344(6):410–417. https://doi.org/10.1056/NEJM200102083440603
doi: 10.1056/NEJM200102083440603
pubmed: 11172177
Lerolle N, Guerot E, Faisy C, Bornstain C, Diehl JL, Fagon JY (2006) Renal failure in septic shock: predictive value of Doppler-based renal arterial resistive index. Intensive Care Med 32(10):1553–1559. https://doi.org/10.1007/s00134-006-0360-x
doi: 10.1007/s00134-006-0360-x
pubmed: 16941165
Schnell D, Deruddre S, Harrois A, Pottecher J, Cosson C, Adoui N, Benhamou D, Vicaut E, Azoulay E, Duranteau J (2012) Renal resistive index better predicts the occurrence of acute kidney injury than cystatin C. Shock 38(6):592–597. https://doi.org/10.1097/SHK.0b013e318271a39c
doi: 10.1097/SHK.0b013e318271a39c
pubmed: 23042202
Parolini C, Noce A, Staffolani E, Giarrizzo GF, Costanzi S, Splendiani G (2009) Renal resistive index and long-term outcome in chronic nephropathies. Radiology 252(3):888–896. https://doi.org/10.1148/radiol.2523080351
doi: 10.1148/radiol.2523080351
pubmed: 19528356
Darmon M, Schortgen F, Vargas F, Liazydi A, Schlemmer B, Brun-Buisson C, Brochard L (2011) Diagnostic accuracy of Doppler renal resistive index for reversibility of acute kidney injury in critically ill patients. Intensive Care Med 37(1):68–76. https://doi.org/10.1007/s00134-010-2050-y
doi: 10.1007/s00134-010-2050-y
pubmed: 20862450
Marik PE, Varon J (2009) Perioperative hypertension: a review of current and emerging therapeutic agents. J Clin Anesth 21(3):220–229. https://doi.org/10.1016/j.jclinane.2008.09.003
doi: 10.1016/j.jclinane.2008.09.003
pubmed: 19464619
Della Rocca G, Pompei L, Costa MG, Coccia C, Scudeller L, Di Marco P, Monaco S, Pietropaoli P (2004) Fenoldopam mesylate and renal function in patients undergoing liver transplantation: a randomized, controlled pilot trial. Anesth Analg 99(6):1604–1609. https://doi.org/10.1213/01.ANE.0000136420.01393.81 table of contents.
doi: 10.1213/01.ANE.0000136420.01393.81
pubmed: 15562040
Naeem M, McEnteggart GE, Murphy TP, Prince E, Ahn S, Soares G (2015) Fenoldopam for the prevention of contrast-induced nephropathy (CIN)-do we need more trials? A meta-analysis. Clin Imaging 39(5):759–764. https://doi.org/10.1016/j.clinimag.2015.02.003
doi: 10.1016/j.clinimag.2015.02.003
pubmed: 25709111
Gillies MA, Kakar V, Parker RJ, Honore PM, Ostermann M (2015) Fenoldopam to prevent acute kidney injury after major surgery-a systematic review and meta-analysis. Crit Care 19:449. https://doi.org/10.1186/s13054-015-1166-4
doi: 10.1186/s13054-015-1166-4
pubmed: 26703329
pmcid: 4699343
Sehgal CM, Arger PH, Silver AC, Patton JA, Saunders HM, Bhattacharyya A, Bell CP (2001) Renal blood flow changes induced with endothelin-1 and fenoldopam mesylate at quantitative Doppler US: initial results in a canine study. Radiology 219(2):419–426. https://doi.org/10.1148/radiology.219.2.r01ma13419
doi: 10.1148/radiology.219.2.r01ma13419
pubmed: 11323466
Radermacher J (2002) Ultrasonogragraphy in the diagnosis of renovascular disease. Imaging Decis 6(2):15–22
doi: 10.1046/j.1617-0830.2002.60204.x
Hunter DW, Chamsuddin A, Bjarnason H, Kowalik K (2001) Preventing contrast-induced nephropathy with fenoldopam. Tech Vasc Interv Radiol 4(1):53–56
doi: 10.1053/tvir.2001.21994
pubmed: 11981789