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Fenoldopam Does Not Prevent Contrast-Induced Nephropathy

Results are in from the largest randomized, placebo-controlled trial to test fenoldopam mesylate for prevention of this complication.

For patients with renal insufficiency who undergo coronary angiography, contrast-induced nephropathy is a common complication. Fenoldopam mesylate, a selective dopamine-1 receptor agonist used for emergency treatment of severe hypertension, has shown promise for preserving renal blood flow after contrast administration.

In a manufacturer-funded, multicenter, randomized trial, 315 patients (mean age, 70; 49% with diabetes) who had a creatinine clearance of <60 mL/minute (mean, 29 mL/minute) and were undergoing cardiac catheterization received either placebo or fenoldopam mesylate. Fenoldopam infusion (titration target, 0.10 µg/kg/minute) was started 1 hour before catheterization and was continued until 12 hours postprocedure. A mean 157 mL of low-osmolar contrast was administered per procedure. About half of both groups received preprocedural N-acetylcysteine.

The incidence of contrast-induced nephropathy, defined as an increase of 25% in serum creatinine level from 24 to 96 hours after completion of study-drug administration, was similar in the 2 groups (fenoldopam, 34%; placebo, 30%). Thirty-day rates of death, dialysis, MI, and rehospitalization also were similar in the 2 groups.

Comment: This was the largest randomized, placebo-controlled trial to test fenoldopam mesylate for limiting contrast-induced nephropathy. The agent failed to prevent this complication in patients with chronic, moderate renal insufficiency. In a recent randomized, placebo-controlled trial involving similar patients, oral acetylcysteine was effective prophylaxis against acute renal dysfunction when administered the day before and the day of elective coronary angiography (Journal Watch Cardiology Mar 7 2003), although further study of that agent is needed.

— JoAnne M. Foody, MD

Published in Journal Watch Cardiology December 5, 2003

Citation(s):

Stone GW et al. for the CONTRAST Investigators. Fenoldopam mesylate for the prevention of contrast-induced nephropathy: A randomized controlled trial. JAMA 2003 Nov 5; 290:2284-91.

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