Division of Hypertension and Nephrology, Department of Systems Medicine, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy.
PhD School of Applied Medical-Surgical Sciences, University of Rome "Tor Vergata", Via Montpellier 1, 00133, Rome, Italy.
J Nephrol. 2019 Feb;32(1):75-81. doi: 10.1007/s40620-018-0496-0. Epub 2018 May 15.
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.
合成药物甲磺酸酚妥拉明（FM）可能具有肾脏保护作用，据报道，静脉（IV）输注 0.1μg/kg/min 的“肾剂量”FM 可增加肾血流量而不影响全身血压。但仍缺乏确凿的数据。我们旨在通过彩色多普勒超声检查来研究该剂量的 FM 静脉给药在高血压慢性肾脏病（CKD）患者中的作用，并验证其是否可能引起任何全身血流动力学改变。
在 60 例高血压 CKD 患者中，我们通过双功多普勒超声检查，在基线和输注 0.1μg/kg/min FM 时，测量了肾门、中间段和双侧肾动脉起源处的收缩期和舒张期血流速度（取样），以及双侧肾间叶动脉的肾内阻力指数（RRI）。根据美国国家肾脏病基金会肾脏病结局质量倡议（NKF-DOQI）的分类，患者被分为四组（I-IV 组）。
输注 0.1μg/kg/min FM 可显著降低 RRI（0.73±0.05 比 0.65±0.06；p<0.0001），并增加所有检查的肾动脉血流速度。未观察到单次全身低血压发作。
非常低剂量的 FM 可显著增加高血压 CKD 患者的肾血流量并发挥肾脏保护作用。以如此低的剂量输注 FM 似乎也非常安全，即使在 CKD 和高血压患者中也是如此。
