Better studies are needed, but a meta-analysis finds benefits with fenoldopam.
Low-dose dopamine has fallen out of favor as an
intervention to prevent renal failure in critically ill patients (Journal
Watch Sep 14 2001). Fenoldopam, a dopamine 
-1-receptor
agonist, has also been studied for this purpose (it is currently
FDA-approved only for inpatient management of severe hypertension).
In a meta-analysis, researchers examined the effect of fenoldopam in
patients at risk for acute renal failure.
Sixteen randomized trials with 1290 patients were identified; intensive-care–unit patients and cardiac surgery patients were studied most commonly. Compared with control treatments (placebo in 11 trials and dopamine in 5), fenoldopam significantly reduced the incidence of variably defined acute renal injury (28.3% vs. 16.0%), need for renal replacement therapy (10.4% vs. 6.5%), and in-hospital mortality (18.9% vs. 15.1%). The quality of most of the studies was considered suboptimal.
Comment: This meta-analysis suggests that fenoldopam may benefit patients who are at risk for acute renal failure related to reduced renal blood flow. One of the larger studies included in this analysis was covered in Journal Watch. Because many studies have been small and flawed, the authors call for a large multicenter randomized trial.
— Allan S. Brett, MD
Published in Journal Watch General Medicine February 6, 2007
Landoni G et al. Beneficial impact of fenoldopam in critically ill patients with or at risk for acute renal failure: A meta-analysis of randomized clinical trials. Am J Kidney Dis 2007 Jan; 49:56-68.