OBJECTIVE: To examine the role of fenoldopam in prevention of contrast media-induced acute renal failure (ARF). DATA SOURCES: A literature search of MEDLINE (from 1966 to October 2000) was performed using the following title search terms: fenoldopam, contrast, and renal failure. STUDY SELECTION: English-language human studies, abstracts, and pertinent animal data were reviewed. DATA SYNTHESIS: Small trials using animals with artificially induced ARF receiving fenoldopam demonstrated improvement in renal function. Preliminary trials in healthy humans have also demonstrated similar results using doses not affecting systemic blood pressure. CONCLUSIONS: Fenoldopam may have a role in the management of ARF induced by contrast dye. However, due to the lack of a large-scale study, it cannot be routinely recommended.