Department of Anesthesiology, Perioperative Medicine and Pain Management, Leonard M. Miller School of Medicine, University of Miami, FL, USA.
Cardiovasc Ther. 2011 Aug;29(4):280-4. doi: 10.1111/j.1755-5922.2010.00217.x. Epub 2010 Oct 18.
Acute kidney injury is a frequent problem among many critically ill patients, commonly in the context of multiple organ failure and decreased renal perfusion. Its presence conveys a poor prognosis. Currently, effective therapeutic interventions are limited and dopaminergic agonists have been suggested as an option to prevent further damage.
We performed a randomized, double-blinded, prospective crossover study in 17 patients admitted to our trauma intensive care unit (ICU) with evidence of impaired renal function. Patients were randomized to a 24-h intravenous infusion of low-dose fenoldopam or placebo. When the infusion of fenoldopam or placebo was completed, patients underwent a 24-h "washout" period in which no study intervention was performed. This sequence was repeated in each patient with the opposite agent, so each patient served as his own control. Four-hour creatinine collections were taken during the last 4 h of each infusion and washout periods to determine creatinine clearance changes during and after the administration of the study drug.
The creatinine clearance was higher with fenoldopam infusion than with placebo infusion (P = 0.045). The FENa was not significantly different.
Our study showed that low-dose Fenoldopam increases creatinine clearance in the critically ill with renal insufficiency. Fenoldopam may be a useful drug in ICU patients with early renal dysfunction.
急性肾损伤是许多危重病患者常见的问题，通常发生在多器官衰竭和肾灌注减少的情况下。它的存在预示着预后不良。目前，有效的治疗干预措施有限，多巴胺激动剂已被提议作为预防进一步损害的一种选择。
我们在 17 名因肾功能受损而入住我们创伤重症监护病房（ICU）的患者中进行了一项随机、双盲、前瞻性交叉研究。患者被随机分配接受 24 小时低剂量非诺多泮静脉输注或安慰剂。当非诺多泮或安慰剂输注完成后，患者在 24 小时的“洗脱”期内不进行任何研究干预。每个患者都重复这个顺序，用相反的药物进行，所以每个患者都是自己的对照。在每个输注和洗脱期的最后 4 小时采集 4 小时肌酐样本，以确定研究药物给药期间和之后的肌酐清除率变化。
非诺多泮输注时的肌酐清除率高于安慰剂输注（P = 0.045）。FENa 没有显著差异。
我们的研究表明，低剂量非诺多泮可增加肾功能不全的危重病患者的肌酐清除率。非诺多泮可能是 ICU 早期肾功能障碍患者的一种有用药物。
