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Dopamine-1 Receptor Agonist: Renal Effects and Its Potential Role in the Management of Radiocontrast-Induced Nephropathy

From the Department of Medicine Division of Nephrology, University of Miami School of Medicine, Miami, Florida.

Radiocontrast-induced nephropathy remains the third leading cause of hospital-acquired acute renal failure. Once established, this syndrome is associated with increased morbidity and mortality as well as increased health care costs. Recently, studies have been initiated to evaluate the potential of a selective dopamine-1 receptor agonist (fenoldopam) in ameliorating radiocontrast-induced renal failure. Selective dopamine-1 receptor agonists exhibit many desirable renal effects that support their use for the prophylaxis of radiocontrast-induced nephropathy, including decreases in renal vascular resistance and increases in renal blood flow, glomerular filtration, and sodium and water excretion. Several reports have documented a beneficial effect of fenoldopam administration in attenuating radiocontrast-induced nephropathy. In contrast, a recent multicenter, randomized study did not demonstrate a renoprotective effect of fenoldopam against radiocontrast-induced nephropathy. The presence of multiple confounders, however, precludes a definitive conclusion regarding the ability of fenoldopam to protect against radiocontrast-induced nephropathy. Additional studies are needed to properly evaluate the role of fenoldopam in radiocontrast-induced nephropathy prophylaxis.

Key Words: Fenoldopam • radiocontrast-induced nephropathy • dopamine-1 receptor agonist

Address for reprints: Murray Epstein, MD, Professor of Medicine, University of Miami School of Medicine, 1600 NW 10th Avenue (R 7168), Miami, FL 33136.

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				N. Pannu, N. Wiebe, M. Tonelli, and for the Alberta Kidney Disease Network Prophylaxis Strategies for Contrast-Induced Nephropathy JAMA, June 21, 2006; 295(23): 2765 - 2779. [Abstract] [Full Text] [PDF]