Renal effects of fenoldopam in critically ill pediatric patients: A retrospective review

Objective: Published data describe the use of fenoldopam in adults for treatment of oliguria/anuria and for renal perfusion and protection, but pediatric data are scant. We assessed the effects of fenoldopam on urine output and potential deleterious changes in hemodynamics or serum creatinine in children. Design: Retrospective analysis. Setting: Academic institution. Patients: All patients <= 18 yrs old at our institution who received >= 24 hrs of fenoldopam therapy. Exclusion criteria included mechanical circulatory support, initiation of fenoldopam in the operating room, and age >18 yrs. Interventions: None. Measurements and Main Results. Demographics, renal function, fenoldopam dosing, concomitant inotropes, and inotrope score data were collected and analyzed. Thirteen patients (age 0.3-18.7 yrs, median 5.5 yrs) received a mean infusion dose of 0.07 +/- 0.08 mu g/kg/min (range 0.01-0.26 mu g/kg/min) over the first 24 hrs of therapy. Eight patients received fenoldopam to augment urine output, and five patients received fenoldopam to increase renal perfusion. Nine (69%) patients received dopamine concurrently. Mean inotrope score at the beginning of therapy was 11.3 +/- 7.6 and did not change during therapy. Mean urine output increased from 1.82 +/- 1.5 mL/kg/hr to 2.74 +/- 1.4 mL/kg/hr (p = .009) in the first 24 hrs of fenoldopam therapy. No change in serum creatinine occurred (p not significant). Blood urea nitrogen was significantly different from baseline (41.7 +/- 18.7 vs. 49.0 +/- 19.8 mg/dL, p = .02). Patients with lower baseline urine output had a greater increase in urine output with fenoldopam. One patient experienced clinically significant hypotension while receiving fenoldopam, which was thought to be due to a concurrent nitroprusside infusion. Conclusions. Fenoldopam increases urine output in select critically ill pediatric patients without requiring escalation of inotropic support. There were no adverse hemodynamic effects or alterations in serum creatinine. Further prospective pediatric studies to define the role of fenoldopam in children are warranted.