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Efficacy and safety of fenoldopam for the treatment of hypertensive crises in children with kidney disease: a retrospective study.
Bertazza Partigiani, Nicola; Vigezzi, Serena; Meneghesso, Davide; Tinnirello, Matteo; Brazzale, Alessandra Rosalba; Daverio, Marco; Vidal, Enrico.
Afiliación
  • Bertazza Partigiani N; Department for Women's and Children's Health, University of Padua, Padua, Italy. nicola.bertazzapartigiani@aopd.veneto.it.
  • Vigezzi S; Department for Women's and Children's Health, University of Padua, Padua, Italy.
  • Meneghesso D; Pediatric Nephrology Unit, Department for Women's and Children's Health, University-Hospital of Padua, Padua, Italy.
  • Tinnirello M; Department for Women's and Children's Health, University of Padua, Padua, Italy.
  • Brazzale AR; Department of Statistical Sciences, University of Padua, Padua, Italy.
  • Daverio M; Pediatric Intensive Care Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy.
  • Vidal E; Pediatric Nephrology Unit, Department for Women's and Children's Health, University-Hospital of Padua, Padua, Italy.
Pediatr Nephrol ; 2024 Sep 09.
Article en En | MEDLINE | ID: mdl-39249125
ABSTRACT

BACKGROUND:

Hypertensive crises in children represent critical medical situations characterized by severe hypertension and potential organ damage. Fenoldopam, a dopaminergic medication, offers a viable therapeutic option for managing such clinical scenarios. We aimed to evaluate efficacy and safety of fenoldopam in the management of hypertensive urgencies and emergencies.

METHODS:

This retrospective analysis focused on pediatric patients affected by acute or chronic kidney disease, aged 1 month-18 years, admitted to the Pediatric Nephrology and the Pediatric Intensive Care Unit at University-Hospital of Padua, Italy, who presented with a hypertensive crisis treated with fenoldopam between March 2010 and December 2022.

RESULTS:

The study included 74 patients with median age 10 years (interquartile range [IQR] 4-15 years) who received 102 fenoldopam infusions. Seventy-two percent were already receiving antihypertensive treatment before admission. In all cases, fenoldopam was associated with a reduction of blood pressure (BP) after 8 h of treatment, but in 87% of patients reduction of the initial mean arterial pressure (MAP) was higher than 25% of calculated drop pressure. MAP normalized in 26% of cases after 24 h and in 35% after 48 h. Occurrence of hypotension was 7%, while hypokalemia was observed in 13% of cases. Patients who presented a MAP reduction not exceeding 25% of calculated drop pressure received a lower median fenoldopam dose (0.2 mcg/kg/min; IQR 0.1-0.2) compared with patients having a MAP reduction > 25% of calculated drop pressure (0.4 mcg/kg/min; IQR 0.2-0.6; p = 0.002).

CONCLUSIONS:

Fenoldopam seems effective and safe for the treatment of hypertensive crises in children with kidney disease, at a starting dose of 0.2 mcg/kg/min. Strict BP monitoring is required to identify possible excessive drop pressure in the first hours of infusion.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Pediatr Nephrol Asunto de la revista: NEFROLOGIA / PEDIATRIA Año: 2024 Tipo del documento: Article País de afiliación: Italia Pais de publicación: Alemania
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Pediatr Nephrol Asunto de la revista: NEFROLOGIA / PEDIATRIA Año: 2024 Tipo del documento: Article País de afiliación: Italia Pais de publicación: Alemania