In Reply We agree with Dr Legrand and colleagues that our study provides further indirect evidence that nonhemodynamic factors may be important to the pathogenesis of AKI after cardiac surgery. We also agree that increases in serum creatinine level represent an already advanced level of decreased GFR, at which time interventions may be less likely to succeed in preserving GFR.
However, in a previous randomized double-blind clinical trial of fenoldopam in which the drug was given at anesthesia induction, we also failed to see a beneficial effect.1 Moreover, although we have conducted several studies of renal biomarkers in the setting of cardiac surgery and the development of AKI,2- 4 we are not aware of any studies conducted among cardiac surgery patients in which interventions triggered by novel biomarkers instead of creatinine level delivered better functional outcomes. Thus, the putative advantage of biomarker-triggered interventions, although interesting and perhaps logical, remains theoretical at this stage.
Bove T, Landoni G, Bellomo R. Fenoldopam and Acute Kidney Injury—Reply. JAMA. 2015;313(9):971. doi:10.1001/jama.2015.436