Cuttone Giuseppe, La Via Luigi, Misseri Giovanni, Geraci Giulio, Sorbello Massimiliano, Pappalardo Federico
Faculty of Medicine and Surgery, Kore University, 94100 Enna, Italy.
Department of Anesthesia and Intensive Care 1, University Hospital Policlinico "G. Rodolico-San Marco", 95123 Catania, Italy.
J Clin Med. 2024 Oct 1;13(19):5863. doi: 10.3390/jcm13195863.
This comprehensive review examines the role of Fenoldopam, a selective dopamine-1 receptor agonist, in preventing and treating acute kidney injury (AKI) during cardiac surgery. AKI remains a significant complication in cardiac surgery, associated with increased morbidity, mortality, and healthcare costs. The review explores Fenoldopam's pharmacological properties, mechanism of action, and clinical applications, synthesizing evidence from randomized controlled trials, meta-analyses, and observational studies. While some studies have shown promising results in improving renal function and reducing AKI incidence, others have failed to demonstrate significant benefits. The review discusses these conflicting findings, explores potential reasons for discrepancies, and identifies areas requiring further research. It also compares Fenoldopam to other renoprotective strategies, including dopamine, diuretics, and N-acetylcysteine. The safety profile of Fenoldopam, including common side effects and contraindications, is addressed. Current guidelines and recommendations for Fenoldopam use in cardiac surgery are presented, along with a cost-effectiveness analysis. The review concludes by outlining future research directions and potential new applications of Fenoldopam in cardiac surgery. By providing a thorough overview of the current state of knowledge, this review aims to facilitate informed decision-making for clinicians and researchers while highlighting areas for future investigation.
这篇综述全面考察了选择性多巴胺-1受体激动剂非诺多泮在心脏手术期间预防和治疗急性肾损伤（AKI）方面的作用。急性肾损伤仍是心脏手术中的一个重大并发症，与发病率、死亡率及医疗费用增加相关。该综述探讨了非诺多泮的药理特性、作用机制及临床应用，综合了来自随机对照试验、荟萃分析和观察性研究的证据。虽然一些研究在改善肾功能和降低急性肾损伤发生率方面显示出了有前景的结果，但其他研究未能证明有显著益处。该综述讨论了这些相互矛盾的发现，探究了差异的潜在原因，并确定了需要进一步研究的领域。它还将非诺多泮与其他肾脏保护策略进行了比较，包括多巴胺、利尿剂和N-乙酰半胱氨酸。阐述了非诺多泮的安全性概况，包括常见副作用和禁忌证。介绍了目前关于在心脏手术中使用非诺多泮的指南和建议，以及成本效益分析。该综述最后概述了非诺多泮在心脏手术中的未来研究方向和潜在新应用。通过全面概述当前的知识状况，本综述旨在促进临床医生和研究人员做出明智的决策，同时突出未来研究的领域。
