Fenoldopam Has No Role in Current CKD Management Guidelines
Fenoldopam (not "fenrinone") is not mentioned in any current major CKD guidelines and should not be used for chronic kidney disease management. The latest KDIGO 2024, KDOQI 2025, and other authoritative guidelines make no recommendations regarding fenoldopam for CKD 1.
What the Latest Guidelines Actually Recommend for CKD
The most recent evidence-based therapies for CKD management include:
Primary Pharmacologic Interventions
SGLT2 inhibitors are recommended to delay CKD progression and reduce cardiovascular events in patients with type 2 diabetes and CKD, particularly those with albuminuria 1, 2
Nonsteroidal mineralocorticoid receptor antagonists (finerenone) are recommended for patients with type 2 diabetes and CKD with albuminuria already on maximum tolerated ACE inhibitors or ARBs to improve cardiovascular outcomes and reduce CKD progression 1, 2, 3
Renin-angiotensin system inhibitors (ACE inhibitors or ARBs) remain foundational therapy for CKD patients with albuminuria ≥30 mg/g 1
Statin therapy is recommended for adults ≥50 years with eGFR <60 mL/min/1.73 m² 1
Blood Pressure Management
- Target BP <140/90 mmHg for CKD patients without albuminuria 1, 3
- Target BP <130/80 mmHg for patients with albuminuria 1, 3
Why Fenoldopam Is Not Recommended for CKD
Limited to Acute Settings Only
Fenoldopam is a selective dopamine-1 receptor agonist studied primarily for:
Acute kidney injury prevention (not chronic management), where evidence shows it probably reduces AKI development but may make little or no difference to need for kidney replacement therapy or death 4
Hypertensive emergencies in patients with impaired renal function, where short-term infusion improved renal blood flow 5
No Evidence for Chronic Use
Studies of fenoldopam in CKD patients used only short-term intravenous infusions (12 hours to a few days), not chronic oral therapy 5, 6, 7
Oral fenoldopam showed only modest blood pressure reduction with no sustained effect on renal function in chronic renal insufficiency patients 7
The drug is not approved or studied for long-term CKD management 4
Critical Distinction
You may be confusing fenoldopam with finerenone, the nonsteroidal mineralocorticoid receptor antagonist that IS recommended in current guidelines for diabetic kidney disease 1, 2, 3. These are completely different medications with different mechanisms and indications.
Common Pitfall to Avoid
Do not use fenoldopam for chronic CKD management—it has no role outside of acute care settings for hypertensive emergencies or potential AKI prevention during high-risk procedures 4, 5. For CKD progression prevention, use the guideline-recommended therapies: SGLT2 inhibitors, finerenone (in diabetic CKD with albuminuria), and RAS inhibitors 1, 2.