Elsevier

Transplantation Proceedings

Volume 39, Issue 6, July–August 2007, Pages 1794-1796
Transplantation Proceedings

Renal
Donor
Fenoldopam vs Dopamine as a Nephroprotective Strategy During Living Donor Kidney Transplantation: Preliminary Data

https://doi.org/10.1016/j.transproceed.2007.05.065Get rights and content

Abstract

Fenoldopam is a selective DA1 agonist with potential nephroprotective capabilities. The aim of this study was to compare the nephroprotective effect of fenoldopam and dopamine during general anesthesia for living donor kidney transplantation.

Methods

Forty donors enrolled in the study received a similar anesthetic and fluid protocol. The patients were randomly divided into group F (receiving 0.1 mg*kg−1*min−1 fenoldopam) versus group D (receiving “renal dose” 3 mg*kg−1*min−1 dopamine). The mean volume of infused fluids, diuresis, and urinary electrolytes (Na, K, Cl) at infusion start and 120 minutes later were studied.

Results

Anthropometric parameters, administered anesthetics, mean infused volume, and urine outputs, did not show significant differences between the groups. Statistically significant differences were observed for urinary excretion of sodium, potassium, and chloride after 120 minutes of continuous fenoldopam infusion, with significant variations within groups for sodium only.

Conclusions

Fenoldopam compared with dopamine resulted in better nephroprotective effects. No adverse events were recorded, and side effects were minimal. Further studies are necessary to evaluate these data.

Section snippets

Materials and Methods

The study was performed during 2004 to 2005, after ethical committee approval and informed consent from the patients. Forty donors were enrolled in the study.

All patients were extensively studied preoperatively for kidney donation. They were all ASA I patients except for two with mild hypertension classified as ASA II. Mean age was 53 ± 6.3 years (range 41–62). All donor-recipient couples were first degree relatives (father/mother-son/daughter).

All patients were randomly divided in group F (20

Results

One patient among 20 in the group F dispayed hypotension (MAP < 75 mm Hg) independent of stopping the fenoldopam continuous infusion while three patients in group D showed tachycardia (1/20 patients HR > 120 bpm), which disappeared with reducted dopamine (2/20 patients) or stopping it (1/20 patients). Neither dobutamine nor administration of extra fluids nor esmolol use were recorded. The fluid infusion protocol was 10 ml*kg−1*h−1, and the mean infused volume did not show a significant

Discussion

Provided there is adequate volume support, an effective nephroprotective strategy should promote urine output as an indirect results of renal blood flow and glomerular filtration rate maintenance, while inducing urinary electrolyte modifications, as the result of tubular ATPase blockade. Whenever renal blood flow or glomerular filtration rate decreases, a complex neuroendocrine and humoral response triggers local and systemic hydroelectrolytic and hemodynamic changes that such to preserve

References (7)

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