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Reviews in Cardiovascular Medicine (RCM) is published by IMR Press from Volume 19 Issue 1 (2018). Previous articles were published by another publisher in Open Access under a CC-BY (or CC-BY-NC-ND) licence, and they are hosted by IMR Press on imrpress.com as a courtesy and upon agreement with MedReviews, LLC.
Open Access
Review
Design and Rationale of CONTRAST--A Prospective, Randomized, Placebo-Controlled Trial of Fenoldopam Mesylate for the Prevention of Radiocontrast Nephropathy
Grgg W. Ston e*, James A.Tu mlin†, Hooman Madyoon‡, NormanE. Lepor§, Peter A.Mc Cullough||, Vandana S. Mathur¶, Patrick T. Murray#, William W.O'Neil**
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1
Lenox Hill Hospital,New York, NY
2
Emory University,Atlanta, GA
3
St. Joseph's Medical Center, Stockton, CA
4
Cedars-Sinai Medical Center, Los Angeles, CA
5
University of Missouri-Kansas City School of Medicine, Truman Medical Center, Kansas City, MO
6
University of California San Francisco, San Francisco, CA
7
University of Chicago,Chicago, IL
8
William Beaumont Hospital, Royal Oak, MI
Rev. Cardiovasc. Med. 2001, 2(S1), 31–36;
Published: 20 January 2001
Abstract
Radiocontrast-induced nephropathy develops in approximately 10% to 20% of patients following administration of iodine-based dye and is one of the most prognostically detrimental complications that invasive cardiologists and radiologists encounter. Preexisting renal dysfunction and diabetes mellitus are two of the most powerful predictors of the likelihood of developing acute renal insufficiency after contrast delivery. To date, only adequate preprocedural hydration and postprocedural hydration to offset dehydration from contrast-induced diuresis have been shown to be effective in preventing this condition. Fenoldopam mesylate, a systemic vasodilator currently FDA - approved for short-term, in-hospital management of severe hypertension, has been shown to increase renal plasma flow in patients with and without chronic renal insufficiency. As a selective agonist of the dopamine-1 receptor, fenoldopam may preserve outer medullary renal blood flow and thereby attenuate radiocontrast-induced nephropathy. Small studies with fenoldopam prior to iodine-based dye administration have demonstrated low rates of radiocontrast nephropathy, and a larger, randomized trial has found that renal blood flow 1 hour after angiography rose in the fenoldopam group compared to a decline in the placebo group. The CONTRAST study has been designed to determine whether fenoldopam is indeed effective in diminishing the occurrence of radiocontrast-induced nephropathy.
Keywords
Radiocontrast-induced nephropathy
Coronary balloon angioplasty
Stent implantation
Atheroablation
Fenoldopam mesylate