The acute effects of a single dopamine infusion in elderly patients with congestive cardiac failure.

Abstract

1. Dopamine (DA) at low doses (2.5 micrograms kg‐1 min‐1) produces a measurable increase in glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) in young healthy subjects and has a therapeutic effect in younger patients with congestive cardiac failure (CCF). In elderly healthy subjects, DA increases ERPF but does not increase GFR in all subjects. 2. To determine the potential therapeutic use of DA in elderly subjects with CCF, we studied 17 patients (5 male) aged 79.9 years (range 68 to 93 years) admitted to hospital for inpatient treatment of CCF resistant to diuretic and angiotensin converting enzyme inhibitor therapy. The effects of a single infusion DA at 2.5 micrograms kg‐1 min‐1 on GFR and ERPF were assessed in a double‐blind, placebo controlled prospective study. 3. There were no significant differences in GFR or ERPF between control and DA. A reduction in GFR was seen in some patients. 4. DA at low dosage was not shown to benefit elderly patients with resistant CCF, and in some patients was detrimental. Higher doses or a combination with other inotropes may be necessary for a renal effect in elderly patients.

2009 Focused Update Incorporated Into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults

“…662 Both patients and physicians frequently attribute the symptoms of HF to aging, and noninvasive cardiac imaging commonly fails to reveal impaired systolic function because HF with a preserved LVEF is frequently found in the elderly. In addition, some reports suggest that elderly patients may have diminished responses to diuretics, ACEIs, and positive inotropic agents [663][664][665] compared with younger patients and may experience a higher risk of adverse effects attributable to treatment. 630,666 -670 Uncertainties regarding the relation of risk to benefit are exacerbated by the fact that very old individuals are poorly represented in large-scale clinical trials designed to evaluate the efficacy and safety of new treatments for HF.…”

Comprehensive Comparison of the Effect of Inotropes on Cardiorenal Syndrome in Patients with Advanced Heart Failure: A Network Meta-Analysis of Randomized Controlled Trials

“…Most of the RCTs exhibited a low risk of bias for the randomization process (37 [100%]) [ 13 , 15 , 18 , 19 , 23 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 ], deviations from the intended interventions (23 [62%]) [ 13 , 15 , 18 , 23 , 27 , 29 , 31 , 33 , 34 , 36 , 38 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 ,…”

“…The prolonged effect of levosimendan might be attributable to these findings. OR-1855 and OR-1896, the active metabolites of levosimendan, had a 1.5-fold half-life (96.5 ± 19.5 h) in patients with severe renal failure with a creatinine clearance of < 30 mL/min [ 51 ]. In addition, due to the improvement in renal function after levosimendan infusion, the excretion of metabolites may be accelerated.…”

“…Most of the RCTs exhibited a low risk of bias for the randomization process (37 [100%]) [13,15,18,19,23,, deviations from the intended interventions (23 [62%]) [13,15,18,23,27,29,31,33,34,36,38,[40][41][42][43][44][45][46][47][48]51,53,54], missing outcome data (34 [92%]) [13,15,18,19,23,[27][28][29][30][31][32][33][34][35][36][37][39][40][41][42][43][...…”