Effects of Fenoldopam in the Pediatric Population: Fluid Status, Serum Biomarkers, and Hemodynamics: A Systematic Review and Meta-Analysis

Abstract

Fluid overload is a frequent complication in children during critical illness. Fluid restriction and diuretic agents have been the mainstay therapies so far. Fenoldopam, a selective dopamine-1 receptor agonist, is a diuretic agent with promising effects in the pediatric population. The purpose of this meta-analysis is to evaluate the outcomes of pediatric patients who received fenoldopam. We hypothesized that the administration of fenoldopam will cause an increase in urine output and decrease in serum creatinine in this patient population. A comprehensive database search of PubMed, EMBASE, and Cochrane libraries from the databases' inception through December 2018 was undertaken. Independent reviewers selected appropriate studies and the reviewed data. A meta-analysis was then conducted to determine the effects of fenoldopam on hemodynamics, the amount of vasoactive support, and renal function in children under the critical care setting. The selected end points were measured prior to the administration of fenoldopam and 24 hours after the initiation of the infusion: urine output, serum creatinine, serum sodium, inotrope score, heart rate, central venous pressure, systolic blood pressure, and mean blood pressure. Forest plots were generated to demonstrate individual study data as well as pooled data for each end point. A total of five studies (three retrospective cohort studies, two randomized trials) with 121 patients were included for analysis. No significant difference was observed in urine output, inotrope score, systolic blood pressure, or mean blood pressure. There was a statistically significant increase in serum creatinine and central venous pressure. There was statistically significant decrease in serum sodium and heart rate, and central venous pressure. This meta-analysis did not identify significant renoprotective or vasodilator effects from fenoldopam in this patient population. Although mild electrolyte and hemodynamic changes were identified, larger studies are warranted to determine the clinical significance of fenoldopam in this patient population.

Keywords

fenoldopam - pediatrics - critical care - hemodynamics

Publication History

Received: 05 February 2020

Accepted: 07 June 2020

Article published online:
10 August 2020

• References

• 1 Mehta RL, Pascual MT, Soroko S, Chertow GM. PICARD Study Group. Diuretics, mortality, and nonrecovery of renal function in acute renal failure. JAMA 2002; 288 (20) 2547-2553
• 2 Murphy MB, Murray C, Shorten GD. Fenoldopam: a selective peripheral dopamine-receptor agonist for the treatment of severe hypertension. N Engl J Med 2001; 345 (21) 1548-1557
• 3 Natarajan AR, Eisner GM, Armando I. et al. The renin-angiotensin and renal dopaminergic systems interact in normotensive humans. J Am Soc Nephrol 2016; 27 (01) 265-279
• 4 Kelly KL, Drobatz KJ, Foster JD. Effect of fenoldopam continuous infusion on glomerular filtration rate and fractional excretion of sodium in healthy dogs. J Vet Intern Med 2016; 30 (05) 1655-1660
• 5 Mathur VS, Swan SK, Lambrecht LJ. et al. The effects of fenoldopam, a selective dopamine receptor agonist, on systemic and renal hemodynamics in normotensive subjects. Crit Care Med 1999; 27 (09) 1832-1837
• 6 Hegde SS, Lokhandwala MF. Renal dopamine and sodium excretion. Am J Hypertens 1990; 3 (6 Pt 2): 78S-81S
• 7 Costello JM, Thiagarajan RR, Dionne RE. et al. Initial experience with fenoldopam after cardiac surgery in neonates with an insufficient response to conventional diuretics. Pediatr Crit Care Med 2006; 7 (01) 28-33
• 8 Moffett BS, Mott AR, Nelson DP, Goldstein SL, Jefferies JL. Renal effects of fenoldopam in critically ill pediatric patients: a retrospective review. Pediatr Crit Care Med 2008; 9 (04) 403-406
• 9 Ricci Z, Luciano R, Favia I. et al. High-dose fenoldopam reduces postoperative neutrophil gelatinase-associated lipocaline and cystatin C levels in pediatric cardiac surgery. Crit Care 2011; 15 (03) R160
• 10 Yoder SE, Yoder BA. An evaluation of off-label fenoldopam use in the neonatal intensive care unit. Am J Perinatol 2009; 26 (10) 745-750
• 11 Ricci Z, Stazi GV, Di Chiara L. et al. Fenoldopam in newborn patients undergoing cardiopulmonary bypass: controlled clinical trial. Interact Cardiovasc Thorac Surg 2008; 7 (06) 1049-1053
• 12 Moffett BS, Orellana R. Use of fenoldopam to increase urine output in a patient with renal insufficiency secondary to septic shock: a case report. Pediatr Crit Care Med 2006; 7 (06) 600-602
• 13 Kumwilaisak K, Noto A, Schmidt UH. et al. Effect of laboratory testing guidelines on the utilization of tests and order entries in a surgical intensive care unit. Crit Care Med 2008; 36 (11) 2993-2999
• 14 Mehari SM, Havill JH. Written guidelines for laboratory testing in intensive care—still effective after 3 years. Crit Care Resusc 2001; 3 (03) 158-162
• 15 Hammer GB, Verghese ST, Drover DR, Yaster M, Tobin JR. Pharmacokinetics and pharmacodynamics of fenoldopam mesylate for blood pressure control in pediatric patients. BMC Anesthesiol 2008; 8: 6
• 16 Murphy MB, McCoy CE, Weber RR, Frederickson ED, Douglas FL, Goldberg LI. Augmentation of renal blood flow and sodium excretion in hypertensive patients during blood pressure reduction by intravenous administration of the dopamine1 agonist fenoldopam. Circulation 1987; 76 (06) 1312-1318
• 17 Weber RR, McCoy CE, Ziemniak JA, Frederickson ED, Goldberg LI, Murphy MB. Pharmacokinetic and pharmacodynamic properties of intravenous fenoldopam, a dopamine1-receptor agonist, in hypertensive patients. Br J Clin Pharmacol 1988; 25 (01) 17-21