***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND AND OBJECTIVE Postoperative renal impairment is a recognized complication of infrarenal aortic cross-clamping . Our hypothesis was that the renal vasodilating and natriuretic effects of fenoldopam mesylate , a selective dopamine ( DA1 ) agonist , would preserve renal function in patients undergoing elective infrarenal aortic cross-clamping . METHODS A prospect i ve , r and omized , double blind controlled clinical trial was performed . Twenty-eight ASA II-III patients undergoing elective aortic surgery requiring infrarenal aortic cross-clamping were studied . According to r and om allocation , patients received either fenoldopam ( 0.1 microg kg(-1 ) min(-1 ) ) or placebo intravenously prior to surgical skin incision until release of the aortic clamp . Plasma creatinine , creatinine clearance , urinary output , fractional excretion of sodium , and free water clearance were measured : ( a ) prior to admission to hospital ; ( b ) during the period from insertion of the urinary catheter until application of the aortic cross-clamp ; ( c ) during the period of aortic cross-clamping ; ( d ) 0 - 4 h , and ( e ) 4 - 8 h after release of the clamp and on days 1 , 2 , 3 , and 5 postoperatively . RESULTS Fenoldopam ( 0.1 microg kg(-1)min(-1 ) ) administration was not associated with haemodynamic instability . On application of the aortic cross-clamp creatinine clearance decreased significantly in the placebo ( 83 + /- 20 to 42 + /- 29 mL min(-1 ) ( mean + /- SD ) ) ( P < 0.01 ) but not in the fenoldopam group , and this decrease persisted for at least 8 h after release of the cross-clamp ( 83 + /- 20 to 54 + /- 33 mL min(-1 ) ( mean + /- SD ) ) ( P < 0.05 ) . Plasma creatinine concentration increased significantly from baseline on the first postoperative day in the placebo group ( 87 + /- 12 to 103 + /- 28 micromolL(-1 ) ( mean + /- SD ) ) ( P < 0.01 ) but not in the fenoldopam group . CONCLUSIONS These findings are consistent with the hypothesis that fenoldopam possesses a renoprotective effect during and after infrarenal aortic cross-clamping Objective : Fenoldopam mesylate is a selective dopamine-1 agonist , with no effect on dopamine-2 and & agr;1 receptors , producing a selective renal vasodilation . This may favor the kidney oxygen supply/dem and ratio and prevent acute renal failure . The aim of the study was to investigate if fenoldopam can provide greater benefit than low-dose dopamine in early renal dysfunction of critically ill patients . Design : Prospect i ve , multiple-center , r and omized , controlled trial . Setting : University and city hospital intensive care units . Patients : One hundred adult critically ill patients with early renal dysfunction ( intensive care unit stay < 1 wk , hemodynamic stability , and urine output ≤0.5 mL/kg over a 6-hr period and /or serum creatinine concentration ≥1.5 mg/dL and ≤ 3.5 mg/dL ) . Interventions : Patients were r and omized to receive 2 & mgr;g/kg/min dopamine ( group D ) or 0.1 & mgr;g/kg/min fenoldopam mesylate ( group F ) . Drugs were administered as continuous infusion over a 4-day period . Measurements and Main Results : Systemic hemodynamic and renal function variables were recorded daily . The two groups were well matched at enrollment for illness severity and hemodynamic and renal dysfunction . No differences in heart rate or systolic , diastolic , or mean arterial pressure were observed between groups  . Fenoldopam produced a more significant reduction in creatinine values compared with dopamine after 2 , 3 , and 4 days of infusion ( change from baseline at time 2 , −0.32 vs. −0.03 mg/dL , p = .047 ; at time 3 , −0.45 vs. −0.09 mg/dL , p = .047 ; and at time 4 , −.041 vs. −0.09 mg/dL , p = .02 , in groups F and D , respectively ) . The maximum decrease in creatinine compared with baseline was significantly greater in group F than group D ( −0.53 ± 0.47 vs. −0.34 ± 0.38 mg/dL , p = .027 ) . Moreover , 66 % of patients in group F had a creatinine decrease > 10 % of the baseline value at the end of infusion , compared with only 46 % in dopamine group ( chi-square = 4.06 , p = .04 ) . Total urinary output during drug infusion was not significantly different between groups . After 1 day , urinary output was lower in group F compared with group D ( p < .05 ) . Conclusions : In critically ill patients , a continuous infusion of fenoldopam at 0.1 & mgr;g/kg/min does not cause any clinical ly significant hemodynamic impairment and improves renal function compared with renal dose dopamine . In the setting of acute early renal dysfunction , before severe renal failure has occurred , the attempt to reverse renal hypoperfusion with fenoldopam is more effective than with low-dose dopamine To test the relative effects on serum creatinine ( CRE ) , blood urea nitrogen ( BUN ) , and urine output of small-dose dopamine and fenoldopam in patients undergoing liver transplantation , we r and omized 43 patients to 1 of 2 continuous infusions over 48 h , starting with anesthesia induction : fenoldopam , 0.1 & mgr;g · kg−1 · min−1 or dopamine , 2 & mgr;g · kg−1 · min−1 . We used predetermined hemodynamic and intravascular volume goals ( intrathoracic blood volume index 800–1000 mL/m2 , extravascular lung water index < 7 mL/kg ) to manage patients with an algorithm for use of mannitol and furosemide to maintain urine output > 1 mL · kg−1 · h−1 . At postoperative day 3 , the median CRE increase was 0.2 mg/dL ( interquartile range [ IQR ] −0.2–0.5 ) with fenoldopam and 0.5 mg/dL ( IQR 0.3–0.9 , P = 0.004 ) in the dopamine group . The BUN increase was median 2 mg/dL ( IQR −2–8 ) versus 8.5 mg/dL ( IQR 5–12 , P = 0.01 ) , respectively , with fenoldopam versus  dopamine . Urine output was similar ; however , significantly fewer fenoldopam patients required furosemide compared with dopamine patients ( median 1 [ IQR 0–3 ] versus 3 [ IQR 2–4 ] , respectively , P = 0.003 ) . The hemodynamic effects  of dopamine and fenoldopam were similar . Compared with dopamine , in the setting of liver transplantation , fenoldopam is associated with better CRE and BUN values Impairment of renal and splanchnic perfusion during and after cardiopulmonary bypass may be responsible for acute renal failure and endotoxin‐mediated systemic inflammation , respectively . We hypothesised that fenoldopam , a selective dopamine receptor agonist , would preserve renal function after cardiopulmonary bypass through its selective renal vasodilatory and natriuretic effects , and increase gastrointestinal mucosal perfusion by selective splanchnic vasodilation . We examined the effects of fenoldopam on haemodynamic parameters , creatinine clearance , fractional excretion of sodium , urine output , free water clearance and gastric mucosal pH in 31 patients undergoing elective coronary revascularisation . Patients were r and omly assigned to receive continuous infusions of fenoldopam 0.1 µg.kg−1.min−1 ( n = 16 ) or placebo ( n = 15 ) . Renal parameters were measured : during a 24‐h period before hospital admission , during cardiopulmonary bypass , from completion of cardiopulmonary bypass until 4 h later , from 4 to 8 h after cardiopulmonary bypass , and from 8 to 14 h after cardiopulmonary bypass . Gastric intramucosal pH was measured using a gastric tonometer before , during and after cardiopulmonary bypass . In the placebo group , but not the fenoldopam group , mean ( SD ) creatinine clearance decreased after separation from cardiopulmonary bypass , from 107 ( 36 ) to 71 ( 22 ) ml.min−1 ( p < 0.01 ) and from 107 ( 36 ) to 79 ( 26 ) ml.min−1 ( p < 0.01 ) for the 0–4 h and 4–8 h intervals after cardiopulmonary bypass , respectively . Changes in intramucosal pH were similar in both groups . The findings are consistent with the hypothesis that fenoldopam possesses a renoprotective effect in patients undergoing cardiopulmonary bypass Background : Inadequate splanchnic perfusion in septic shock is associated with increased morbidity and mortality . As result of splanchnic ischemia , mucosal permeability increases . Considering the implication of improved mucosal perfusion in terms of maintenance of mucosal barrier integrity , dopamine-1 receptor stimulation could be helpful in septic shock . The goal of the current study was to determine the effects of fenoldopam on systemic hemodynamic parameters and gastric mucosal perfusion in patients with septic shock . Furthermore , the authors tested the hypothesis that the addition of fenoldopam ( 0.1 & mgr;g · kg−1 · min−1 ) to a combination of norepinephrine and dobutamine ( 5 & mgr;g · kg−1 · min−1 ) may improve gastric mucosal perfusion in septic shock . Methods : Patients with septic shock were r and omized to a double-blind 2-h infusion of fenoldopam ( n = 20 ) or placebo ( n = 20 ) . Each group received dobutamine ( 5 & mgr;g · kg−1 · min−1 ) , and the dosage of norepinephrine was adjusted to achieve a mean arterial pressure between 70 and 80 mmHg . A laser-Doppler probe and tonometer were introduced into the gastric lumen . Results : A significant increase in gastric mucosal perfusion , detected by laser-Doppler flowmetry , was observed in the group treated with fenoldopam ( P < 0.05 ) . In addition , this increase in microcirculatory flow occurred despite the fact that systemic flow remained unchanged . Differences in gastroarterial partial pressure of carbon dioxide values were not statistically significant in the fenoldopam and placebo groups . Conclusions : The study showed that , for the same mean arterial pressure , short-term fenoldopam infusion increased gastric mucosal perfusion in patients with septic shock CONTEXT The development of contrast-induced nephropathy in patients undergoing invasive cardiac procedures is associated with a marked increase in cardiovascular morbidity and mortality .  Fenoldopam mesylate , a specific agonist of the dopamine-1 receptor , preserves renal blood flow after iodinated contrast administration and has shown promise in ameliorating contrast nephropathy in previous observational and small r and omized trials . OBJECTIVE To examine the efficacy of fenoldopam mesylate in preventing contrast nephropathy after invasive cardiovascular procedures . DESIGN Prospect i ve , placebo-controlled , double-blind , multicenter r and omized trial with serial serum creatinine levels measured at a central biochemistry laboratory ( at baseline and 1 , 24 , 48 , and 72 to 96 hours after study drug administration ) and 30-day clinical follow-up . PATIENTS AND SETTING Between March 2001 and July 2002 , 315 patients with creatinine clearance less than 60 mL/min ( 1.00 mL/s ) at 28 centers in the United States were r and omized to receive fenoldopam mesylate ( n = 157 ) or placebo ( n = 158 ) . INTERVENTIONS Patients were hydrated and r and omized to receive intravenous fenoldopam ( 0.05 microg/kg/min titrated to 0.10 microg/kg/min ) vs matching placebo , starting 1 hour prior to angiography and continuing for 12 hours . MAIN OUTCOME MEASURE Contrast-induced nephropathy , defined as an increase of 25 % or more in serum creatinine level within 96 hours postprocedure . RESULTS Mean ( SD ) patient age was 70 ( 11 ) years , and 49 % had diabetes mellitus .  Mean ( SD ) baseline creatinine clearance was 29.0 ( 10.0 ) mL/min ( 0.48 [ 0.16 ] mL/s ) ( range , 7.5 - 56.8 mL/min [ 0.12 - 0.94 m 
    Output:
    
This analysis suggests that fenoldopam reduces the need for renal replacement and mortality in patients with acute kidney injury .