Differential Effects Between Intravenous and Targeted Renal Delivery of Fenoldopam on Renal Function and Blood Pressure in Patients Undergoing Cardiac Catheterization

Published:February 27, 2006DOI:
      A randomized, controlled clinical trial demonstrated that intravenous (IV) fenoldopam did not prevent further deterioration in renal function after contrast administration in patients with chronic renal insufficiency. This lack of effect may have been a consequence of the inability to administer an effective renal dose of IV fenoldopam. This study sought to determine whether compared with IV administration, selective intrarenal (IR) fenoldopam would increase local concentration, leading to a higher glomerular filtration rate (GFR), and, because of first-pass renal elimination, result in lower systemic drug levels and less decrease in systemic blood pressure (BP). A randomized, controlled, open-label, partial crossover design trial was conducted in which 33 patients who underwent coronary angiography were randomized in a 1:2 ratio to control or fenoldopam (initially IV, then crossed over to IR through a bifurcated renal infusion catheter). Compared with IV fenoldopam, IR administration was associated with a significantly higher GFR (73.7 ± 3.1 vs 62.6 ± 2.5 ml/min, p = 0.0007) and renal plasma flow (537.2 ± 34.0 vs 494.0 ± 35.5 ml/min, p <0.01), lower fenoldopam plasma levels (3.3 ± 0.3 vs 4.8 ± 0.3 ng/ml, p <0.0001), and greater nadir systolic BP (125.5 ± 3.6 vs 117.4 ± 2.8 mm Hg, p <0.0001). Two hours after drug discontinuation after contrast administration, GFRs in the patients who received IR fenoldopam remained higher than in controls (+15.0 ml/min [+25%] vs −8.0 ml/min [−14.0%], p <0.05). In conclusion, this pilot trial demonstrates that the IR infusion of fenoldopam is safe and practical, producing greater renal effect and less reduction of BP than IV infusion. It would be appropriate to restudy this renal vasodilator for the prevention of contrast nephropathy, using selective IR delivery.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • McCullough P.A.
        • Soman S.S.
        Contrast-induced nephropathy.
        Crit Care Clin. 2005; 21: 261-280
        • Gruberg L.
        • Mintz G.S.
        • Mehran R.
        • Gangas G.
        • Lansky A.J.
        • Kent K.M.
        • Pichard A.D.
        • Satler L.F.
        • Leon M.B.
        The prognostic implications of further renal function deterioration within 48 h of interventional coronary procedures in patients with pre-existent chronic renal insufficiency.
        J Am Coll Cardiol. 2000; 36: 1542-1548
        • Stone G.W.
        • McCullough P.A.
        • Tumlin J.A.
        • Lepor N.E.
        • Madyoon H.
        • Murray P.
        • Wang A.
        • Chu A.A.
        • Schaer G.L.
        • Stevens M.
        • et al.
        • CONTRAST Investigators
        Fenoldopam mesylate for the prevention of contrast-induced nephropathy.
        JAMA. 2003; 290: 2284-2291
        • Tumlin J.A.
        • Wang A.
        • Murray P.T.
        • Mathur V.S.
        Fenoldopam mesylate blocks reductions in renal plasma flow after radiocontrast dye infusion.
        Am Heart J. 2002; 143: 894-903
        • Madyoon H.
        • Croushore L.
        • Weaver D.
        • Mathur V.
        Use of fenoldopam to prevent radiocontrast nephropathy in high-risk patients.
        Catheter Cardiovasc Interv. 2001; 53: 341-345
        • Chamsuddin A.A.
        • Kowalik K.J.
        • Bjarnason H.
        • Dietz C.A.
        • Rosenberg M.S.
        • Gomes M.D.
        • McDermott C.M.
        • Hunter D.W.
        Using a dopamine type 1A receptor agonist in high-risk patients to ameliorate contrast-associated nephropathy.
        Am J Roentgenol. 2002; 179: 591-596
        • Schnurr E.
        • Lahme W.
        • Kuppers H.
        Measurement of renal clearance of inulin and PAH in the steady state without urine collection.
        Clin Nephrol. 1980; 13: 26-29
        • Cole B.R.
        • Giangiacomo J.
        • Ingelfinger J.R.
        • Robson A.M.
        Measurement of renal function without urine collection. A critical evaluation of the constant-infusion technic for determination of inulin and para-aminohippurate.
        N Engl J Med. 1972; 287: 1109-1114
        • Boppana V.K.
        • Dolce K.M.
        • Cyronak M.J.
        • Ziemniak J.A.
        Simplified procedures for the determination of fenoldopam and its metabolites in human plasma by high-performance liquid chromatography with electrochemical detection.
        J Chromatogr. 1989; 487: 385-399
        • Liss P.
        • Nygren A.
        • Erikson U.
        • Ulfendahl H.R.
        Injection of low and iso-osmolar contrast medium decreases oxygen tension in the renal medulla.
        Kidney Int. 1998; 53: 698-702