Hemodynamics and renal function during administration of low-dose dopamine in severely ill patients

Abstract

CONTEXT: Although a large number of studies have been performed regarding the renal and hemodynamic effects of the infusion of low-dose dopamine (LDD) in severely ill patients, there is still controversy on this subject. OBJECTIVE: To evaluate the effects of dopamine (2 mug/kg/min) on systemic hemodynamics (lowest mean arterial pressure, MAP, highest heart rate, HR, central venous pressure, CVP), creatinine clearance (CLcr), diuresis and fractional sodium excretion (FENa+). TYPE OF STUDY: A non-randomized, open, prospective clinical trial. SETTING: An intensive care unit in a tertiary university hospital. PARTICIPANTS: 22 patients with hemodynamic stability admitted to the intensive care unit. PROCEDURES: Patients were submitted to three two-hour periods: without dopamine (P1), with dopamine (P2) and without dopamine (P3). MAIN MEASUREMENTS: The abovementioned variables were measured during each period. CLcr was assessed based upon the formula U x V/P, where U is urinary creatinine (mg/dl), V is diuresis in ml/min and P is serum creatinine (mg/dl). FENa+ was calculated based upon the formula: urinary sodium (mEq/l) x P/plasma sodium (mEq/l) x U) x 100. Results were presented as mean and standard deviation. The Student t test was used and results were considered significant if p was less than 0.05. RESULTS: Twelve patients (seven males and five females) were included, with a mean age of 55.45 years. There was no significant variation in MAP, HR, CVP, CLcr or FENa+ with a dopamine dose of 2 mug/kg/min. On the other hand, diuresis significantly increased during P2, from 225.4 to 333.9 ml. CONCLUSION: Infusion of 2 mug/kg/min of dopamine for 2 hours increases diuresis. At the doses studied, dopamine does not induce significant alterations in MAP, HR, CVP, CLcr and FENa+.

Acute renal failure in the elderly: particular characteristics

“…• Low dose dopamine, on the other hand, has no proven benefit, although widely used [32,33]. • Calcium channel blockers have been proven useful in preventing ARF, at least in cases after cardiac surgery [34].…”

Oxidative Stress and Acute Kidney Injury in Critical Illness: Pathophysiologic Mechanisms—Biomarkers—Interventions, and Future Perspectives

“…Earlier efforts to show benefit in renal outcome in critical care setting through administration of low-dose dopamine in continuous infusion have shown a temporary benefit in urine output [101], but with no significant protection against the development of AKI, the prevention of RRT, and mortality according to meta-analyses [102–104]. In the same patient group, fenoldopam seems to be superior compared to dopamine in the improvement of serum creatinine levels when renal dysfunction is present [105] and according to a meta-analysis in 1290 patients, fenoldopam administration reduced the need for RRT support and intensive care unit hospitalization [106].…”

Methotrexate renal clearance by low-dose dopamine in severe nephrotoxicity

“…Dopamine at ''renal'' dosage is a known glomerular vasodilator, that reduce resistances and improves renal blood flow. 4 Here, we present two cases of severe MTX nephrotoxicity. Case #2 was successfully treated by infusion of low-dose dopamine showing effective MTX renal clearance, resulting in a fast and complete recovery of kidney function.…”