KDIGO Clinical Practice Guideline for Acute Kidney Injury
Fenoldopam: Recommendations and Rationale

Fenoldopam

• 4.4.5: We recommend not using fenoldopam to prevent CI-AKI. (1B)

Rationale

Fenoldopam is a selective dopamine A1 receptor agonist that might theoretically increase blood flow, especially to the renal medulla. Several uncontrolled studies (historical controls, retrospective review) suggested that it is effective in reducing the risk for contrast-induced nephropathy, and the results of a pilot trial were promising (for review, see Stacul et al.⁵¹²). However, two prospective randomized trials showed negative results.^220,513 In the first trial,⁵¹³ patients were randomized to saline alone or with fenoldopam (0.1 µg/kg per minute for 4 hours before and after the procedure); a third arm was treated with NAC. The incidence of CI-AKI was similar in the fenoldopam (15.7%) and control (15.3%) groups, and there was no benefit over saline alone. A second, larger trial²²⁰ also confirmed the lack of benefit with fenoldopam. In this double-blind trial of 315 patients, all with saline 0.45%, were randomized to fenoldopam (0.05 µg/kg per minute titrated to 0.1 µg/kg per minute) or placebo starting 1 h before the procedure and continuing for 12 hours afterward. There was no significant difference in the incidence of CI-AKI within 96 hours in the two groups (fenoldopam, 33.6%; placebo, 30.1%) or in the rates of dialysis, rehospitalization, or death at 30 days.