The benefit of low‐dose dopamine during vigorous diuresis for congestive heart failure associated with renal insufficiency: Does it protect renal function?

Abstract

SummaryBackground: Low-dose dopamine, a renal vasodilator, has been used empirically to improve renal function or outcome in critically ill patients with oliguria or acute renal failure.Hypothesis: This study was designed to investigate the efficacy of low-dose dopamine (2 pg/kg/min) as a renal-protecrive agent during vigorous diuresis for congestive heart failure (CHF) associated with mild or moderate renal insufficiency.Mrfhods: Of 20 study patients (mean age 74.3 k 15 years) with severe CHF, 10 (Group A) were randomized to a treatment strategy of intravenous bumetanide ( I mg b.i.d.) alone and another 10 (Group B) to low-dose dopamine and a similar diuretic regimen for a duration of 5 days or less if clinical

Management of diuretic-refractory, volume-overloaded patients with acutely decompensated heart failure

“…Renaldose dopamine appears to have physiologic effects suggesting that it should improve diuresis, yet the only comprehensive assessment of the utility of renal dopamine excludes patients with heart failure [33], due to the paucity of literature examining its effects in such patients. One study evaluated the effects on renal function in heart failure patients admitted with volume excess [34]. Although the addition of dopamine to diuretics was associated with marked improvement in renal function after 5 days, this assessment was made in patients who were not refractory to diuretics.…”

“…Further, dopamine can impair ventilatory responsiveness in heart failure patients via effects on the chemoreflex sensitivity [35]. Therefore, even though one study suggests its utility [34], the relatively widespread use of renal dopamine should not be advocated regularly until definitive data can support its safety and efficacy.…”

Volume Overload in Heart Failure

“…In this study, urine output increased 24% in the first 24 hours. 42 Because only 1 small study included in these reviews specifically included patients with HF, 43 3 studies were conducted evaluating low-dose dopamine for ADHF treatment. A retrospective study assessed 116 patients receiving furosemide by continuous infusion coupled with low-dose dopamine or bolus intravenous furosemide alone.…”

ROSE-AHF and Lessons Learned

“…Two small single center open label studies done in the late 1990s revealed a potential renoprotective effect of low-dose dopamine in combination with diuretics during aggressive diuresis in patients with AHF [8, 9]. Renal function (measured by BUN, serum creatinine, creatinine clearance and urine output) was improved in a small study of 20 AHF patients receiving dopamine (2 μg/Kg/min) with bumetanide as compared to bumetanide alone [9].…”