Fenoldopam and Acute Kidney Injury: Is It Time to Turn the Page?

The use of low-dose dopamine for renal protection has been firstly described more than 50 years ago and has tenaciously resisted until recently. However, it is now clear that this intervention is, on average, not effective for prevention or early treatment of acute kidney injury (AKI) and may even be harmful. Nevertheless, a new enthusiasm has developed during the last decade for a possible nephroprotective action of fenoldopam, a specific dopamine type-1 receptor agonist with a renal action similar to that of low-dose dopamine, but theoretically more favorable and without the adverse effects related to systemic adrenergic stimulation. Fenoldopam remained, until recently, one of the few drugs which were thought to have a potential beneficial effect on renal function, as well as on outcome, in critically ill patients with or at risk for AKI. However, the largest multicenter randomized controlled trial addressing the impact of fenoldopam on the need for renal replacement therapy and on mortality in patients with early cardiac surgery-associated AKI, recently published, seriously questioned the effectiveness (and also the safety) of this strategy.