Renal, but not systemic, hemodynamic effects of dopamine are influenced by the severity of congestive heart failure*

Abstract

The dose of dopamine producing an optimal improvement of systemic and renal hemodynamics in congestive heart failure is higher than usually reported. A greater clinical severity of congestive heart failure impairs the renal effects of dopamine, probably through a selective loss in renal vasodilating capacity.

Renal Vasodilatory Action of Dopamine in Patients With Heart Failure

“…11 For many years, a small dose of dopamine often has been used by clinicians to enhance RBF in critically ill patients 12,13 ; however, this selective effect of dopamine on the renal circulation may be eliminated or markedly attenuated by other vasoconstrictive mechanisms known to be activated in patients with HF. 14 In addition, the magnitude of its renal vasodilatory effects and site of action in patients with HF have not been clearly defined. The introduction of intravascular ultrasound (IVUS) and Doppler techniques provides an opportunity for further insight, because these techniques allow for an accurate assessment of vascular dimensions and blood flow velocity and can be used for evaluation of vasodilatory changes in both the conductance (IVUS) and resistance (Doppler) renal blood vessels.…”

Cardiorenal Syndrome

“…76 Although dopamine has occasionally been shown to improve renal function, it appears that this improvement might be secondary to increased cardiac output rather than a local effect. 77 Improved renal function has not been demonstrated with fenoldopam, which appears to increase cardiac output secondary to vasodilation. 78 Inotropic therapy will continue to be used in patients with worsening renal function presumed to be secondary to decreased cardiac output.…”

Current treatment options for early management in acute decompensated heart failure

“…If systemic blood pressure is reduced, dobutamine (2.5 μg/kg/min to 10 μg/kg/min infusion) may be preferred due to its more prominent positive inotropic and lesser vasodilatory effect, while dopamine (5 μg/kg/min to 20 μg/kg/min) should be used in patients with low arterial blood pressure due to its vasoconstrictive effects (37)(38)(39)(40)43,44). Other vasodilators, such as calcium sensitizers, were received initially with much promise, although subsequent properly controlled studies did not duplicate the initial small randomized studies (45).…”