Pharmacological interventions for renal protection in the perioperative period

Pharmacological interventions for renal protection in the perioperative periodAt present, no convincing evidence indicates that any of these measures are of benefit.

1. Diuretics are used to facilitate management of fluid balance and manage electrolyte and acid-base disturbances (Table 5.4). However, the KDIGO guidelines 2012 recommend against use of diuretics specifically to prevent or treat AKI, except in management of volume overload. There is no evidence that use of diuretic therapy reduce severity or mortality in AKI. In fact, it may precipitate AKI.
2. Dopamine dilates renal arterioles, increases renal blood flow, and augments natriuresis and the GFR. Low-dose dopamine (0.5-3 μg/kg/min) has been proposed to prevent and treat AKI, but efficacy has never been demonstrated.
3. Fenoldopam is a specific dopamine-1 receptor agonist. Emerging data suggest possible protective effects in AKI; larger studies are needed. It is found to be ineffective for prevention of CI-AKI.
4. Natriuretic peptides: There are currently no definitive trials to support use of ANP, BNP, or nesiritide.