ArticlesLow-dose dopamine in patients with early renal dysfunction: a placebo-controlled randomised trial*
Introduction
Physicians and surgeons in many countries commonly use low-dose dopamine in critically ill patients because, in healthy volunteers, it increases renal blood flow and induces natriuresis and diuresis.1, 2 Although these haemodynamic and diuretic effects are expected to afford a clinically significant degree of renal protection in patients at risk of acute renal failure,3 no large controlled trials have been done to test whether administration of dopamine attenuates renal injury.4 Furthermore, there is concern about the potential adverse effects of low-dose dopamine on pituitary function, T-cell responsiveness, and gastrointestinal oxygenation.5, 6, 7 We undertook a multicentre, randomised, double-blind, placebo-controlled trial of low-dose dopamine infusion in intensive-care-unit (ICU) patients at risk of acute renal failure to assess whether dopamine attenuated the rise in serum creatinine.
Section snippets
Patients
Between March, 1996, and April, 1999, we screened patients admitted to 23 participating ICUs to identify adult patients who met our inclusion criteria. These criteria were: presence of a central venous catheter; two or more of the pathophysiological changes of the systemic inflammatory syndrome (SIRS)8 over a 24 h period; and at least one indicator of early renal dysfunction (urine output averaging < 0·5 mL/kg hourly over 4 h or longer; serum creatinine concentration >150 μmol/L in the absence
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2022, British Journal of AnaesthesiaCitation Excerpt :Increased medullary blood flow during dopamine therapy appears to be counterbalanced by increased solute load, and thus medullary oxygen consumption, so medullary tissue Po2 is not increased.107 Clinical trials using dopamine125 or the D1-receptors agonist fenoldopam126 have failed to demonstrate improved renal outcomes. Levosimendan, an inodilator, acts by increasing myocardial calcium sensitivity and opening ATP-dependent potassium channels in vascular smooth muscle.127
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