dopamine receptor agonist (fenodopam) (outer medulla) [1] 1 Hunter et al [3] fenodopam 29 ( 2.3 mg/ dl) fenodopam 1. Fenodopam

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1 (outer medulla) [1] 1 Hunter et al [3] fenodopam 29 ( 2.3 mg/ dl) 2 fenodopam 0.1 µ g/kg/min µ g/kg/ min 0.5 µ g/kg/min Fenodopam % dopamine receptor agonist 0.2 mg/dl 1.4 mg/dl (acetylcysteine) fenodopam [2] dopamine receptor agonist (fenodopam) Madyoon et al [4] (retrospective analysis) Hunter et al fenodopam dopamine dopamine-1 Hunter el at α β adrenergic effect fenodopam 1. Fenodopam ( 2) Fenodopam dose (µg/kg/h) Hunter et al Madyoon et al Kini, Sharma Tumlin et al Stone et al

2 Kini and Sharma [5] species) (NO) 110 ( 1.5 mg/dl 2 Tepel et al [6] ( : mg/dl) ) fenodopam ( 600 mg bid for µg/kg/min ) (2% vs 21% p 0.01) 177 Diaz-Sandoval et al fenodopam Briguori et al [7] (4.5% vs 18.8% 183 p 0.009) 4 (3.8%) fenodopam ( 90 ) ( ) ) fenodopam ( vs 6.5% 11% p 0.22) Briguori et al Tepel et al ( ml vs 75 ml) 315 Briguori et al 60 ml/min (n 157) ( 140 ml) 158) fenodopam 0.05 µg/kg/min 0.1 µg/kg/min 8.5% p 0.02 ) (feno- Birck et al [8] dopam vs control 33.6% vs 30.1% p 0.61) fenodopam 7 fenodopam 0.1 µg/kg/min to p 0.02) fenodopam (acetylcysteine) days ) ( ( 600 mg bid for 2 days ( vs 0% 56% (relative risk % confidence interval (acetylcysteine) (reactive oxygen

3 2. (NAC, N-acetylcysteine) Tepel et al Diaz-Sandoval et al Shyu et al Kay et al Baker et al Briguori et al Durham et al mg * mg * mg * mg * 80 ** mg 79 *** * ** 150 mg/kg in N/S 500 cc for 30 min 50 mg/kg in N/S 500 cc over 4 hr *** mg 15 ) (p 0.05) [10] 129 ( 1.5 (ratio) 3.5 mg/dl) 500 cc (Iodixanol) (ration of 1.5) (ration of 3) (Iohexol) (ratio of 6) ( 3) 3 (Iodixanol) (Iohexol) (0.13 mg/dl vs 0.55 mg/dl p 0.001) 0.5 mg/dl Chalmers and Jackson [9] (Iodixanol) 3% (64 2 ) 124 (Iohexol) 26% (65 17 ) (p 0.001) 1.0 mg/dl (Iodixanol) (Iohexol) (Iodixanol) 0% (Iohexol) 15% (65 10 ) 24 25% (Iodixanol) 3.7% (54 2 ) (Iohexol) 10% (48 5 ) 10% (Iodixanol) 15% (54 8 ) (Iohexol) 31% (

4 3. ( 2) (mosm/kg) Diatrizoate Iothalamate 3.0 Iohexol 780 Iopamidol Iotrolan 320 Iodixanol ( 2) Vogt et al Frank et al Marenzi et al 113 * 17 ** 114 *** * 4 6 ** 4 *** cc/kg (54 15 ml/min vs ml/min p 0.001) Vogt B el al [11] Frank et al [12] 17 Marenzi et al [13] 3 mg/dl (n 7) (n )

5 (n mg/ (0.7% vs 2% p 0.04) dl) (n mg/dl ) (isotonic saline [n 138] 2% half-isotonic sa- 4 6 line [n 148] 4% p 0.36) ml/hr (isotonic saline [n 107] 0% half-isotonic saline (in-hospital morbidity and mortality) ( cumulative 1-year mortality rate) half-isotonic saline [n 268 ] 3% p 0.01) (isotonic saline [n 107] 0% half-iso- tonic saline [n 110] 5.5% p 0.01) (5% vs 50%, p 0.001) (2% vs 14%, p 0.02) (10% vs 30%, p 0.01) 3% 25% 9% 52% (p 0.001) (acetylcysteine) vs Mueller et al [14] nephropathy. AJKD 2004; 44: ( mg/dl) 0.5 mg/dl [n 176 ] 5.1% p 0.01) ( 250 ml) (isotonic saline [n 251] 0% 1. McCullough PA, Wolyn R, Rocher LL, et al: Acute renal failure after coronary intervention; Incidence, risk factors, and relationships to mortality. Am J Med 1997; 103: Arif Asif, Murray Epstein: Prevention of radiocontrast-induced 3. Hunter DW,Chamsuddin A,Bjarnason H et al: Preventing contrast-induced nephropathy with fenodopam. Tech Vasc Interv Radiol 2001; 4: Madyoon H, Croushore L, Weaver D, et al: Use of fenodopam to prevent radiocontrast nephropathy in high-risk patients. Catheter Cardiovasc Interv 2001; 53: Kini AA, Sharma SK: Managing the high-risk patient: Experience with fenodopam, a selective dopamine receptor agonist, in prevention of radiocontrast nephropathy during percutaneous coronary intervention. Rev Cardiovasc Med 2001; 2: s19- s

6 6. Tepel M, Van der Giet M, Schwarzfeld C, et al: Prevention of radiographic-contrast-agent-induced reductions in renal function by acetylcysteine.n Engl J Med 2000; 343: Briguori C, Manganelli F, Scarpato P: Acetylcysteine and contrast agent-associated nephrotoxicity. J Am Coll Cardiol 2002; 40: Birck R, Krzossok S, Markowetz F, Schnulle P, van der Woude FJ, Braun C: Acetylcysteine for prevention of contrast nephropathy: Meta-analysis. Lancet 2003; 362: Chalmers N, Jackson RW: Comparison of iodixanol and iohexol in renal impairment. Br J Radiol 1999; 72: Aspelin P, Aubry P, Fransson SG, et al: Nephrotoxicity in high-risk patients study of iso-osmolar and low-osmolar nonionic contrast media study investigators:nephrotoxic effects in high-risk patients undergoing angiography. N Engl J Med 2003; 348: Vogt B, Ferrari P, Schonholzer C: Prophylactic hemodialysis after radiocontrast media in patients with renal insufficiency is potentially harmful. Am J Med 2001; 111: Frank H, Werner D, Lorusso V: Simultaneous hemodialysis during coronary angiography fails to prevent radiocontrastinduced nephropathy in chronic renal failure. Clin Nephrol 2003; 60: Marenzi G, Marana I, Lauri G: The prevention of radiocontrast-agent-induced nephropathy by hemofiltration. N Engl J Med 2003; 349: Mueller C, Buerkle G, Buettner HJ: Prevention of contrast media-associated nephropathy; Randomized comparison of 2 hydration regimens in 1620 patients undergoing coronary angioplasty. Arch Intern Med 2002; 162: