• Linda F Barr and Kenneth Kolodner.
• Johns Hopkins Medical Institutions, Division of Pulmonary and Critical Care Medicine, Baltimore, MD, USA. lindafbarr@yahoo.com
• Crit. Care Med. 2008 May 1;36(5):1427-35.

ObjectiveTo determine whether fenoldopam and N-acetylcysteine prevent renal deterioration and improve hospital outcome for patients with chronic renal insufficiency undergoing cardiac surgery.DesignProspective, randomized, double-blinded, placebo-controlled trial.SettingA community hospital that is a cardiac referral center.PatientsSeventy-nine adult patients with chronic renal insufficiency (creatinine clearance < or = 40 mL/min) who underwent cardiac surgery.InterventionsGroup 1 received intravenous fenoldopam 0.1 microg/kg/min started at surgical induction and continued for 48 hrs. Group 2 received N-acetylcysteine 600 mg orally twice a day, from preoperative day 1 to postoperative day 1. Group 3 received both fenoldopam and N-acetylcysteine, and group 4 patients served as controls.Measurements And Main ResultsUsing multiple comparisons (analysis of variance) with change scores, and statistically adjusting for group differences in aortic cross-clamp time, use of intraoperative aprotinin, and preoperative use of statin, we found that the change in creatinine clearance from preoperative to postoperative day 3 was statistically less for group 1 (-1.47 mL/min +/- 2.06 SE, p = .0286) and for group 2 (-0.67 mL/min +/- 2.11 SE, p = .0198) and less but not quite significant for group 3 (-3.08 mL/min +/- 1.95 SE, p = .0891) compared with controls (-8.15 mL/min +/- 2.18 SE). Furthermore, the adjusted weight gain on postoperative day 3 was 5.55 kg +/- 1.00 SE (p = .0988) for group 1, 5.06 kg +/- 1.06 SE (p = .0631) for group 2, and 5.14 kg +/- .91 SE (p = .0445) for group 3 compared with 8.03 kg +/- 1.07 SE for group 4. However, there was no decrease in length of critical care or hospital stay or hospital costs. Finally, fenoldopam contributed to perioperative hypotension.ConclusionsPerioperative fenoldopam and N-acetylcysteine abrogate the early postoperative decline in renal function of patients who have chronic renal insufficiency, although these agents do not affect other parameters of cardiac surgical outcome.

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