Is the administration of dopamine associated with adverse or favorable outcomes in acute renal failure? Auriculin Anaritide Acute Renal Failure Study Group.
OBJECTIVE
To explore the relationship between the administration of low-dose dopamine and outcomes in acute renal failure.


METHODS
Two hundred and fifty-six patients with acute renal failure randomized to the placebo arm of a multicenter intervention trial were examined. Independent correlates of low-dose (arbitrarily defined as < 3 micrograms/kg/min) and high-dose (arbitrarily defined as > or = 3 micrograms/kg/min) dopamine administration were identified. The relative risks of death, and the combined outcome of death or dialysis, were estimated using proportional hazards regression with and without adjustment for potential confounding and bias.


RESULTS
There were 93 (36%) deaths documented; an additional 52 (20%) patients who survived required dialysis during the 60-day study period. The relative risk (RR) of death associated with the administration of low-dose dopamine was 1.11 (95% confidence interval [95% Cl] 0.66 to 1.89). The RR of death was modestly but not significantly reduced, after adjustment for the probability of treatment assignment and for relevant covariates (RR 0.82, 95% Cl 0.42 to 1.60). The RR of death or dialysis associated with the administration of low-dose dopamine was 1.10 (95% Cl 0.71 to 1.71). The RR of death or dialysis was attenuated by adjustment, but not significantly (RR 0.95, 95% Cl 0.58 to 1.58).


CONCLUSIONS
There is insufficient evidence that the administration of low-dose dopamine improves survival or obviates the need for dialysis in persons with acute renal failure. The routine use of low-dose dopamine should be discouraged until a prospective, randomized, placebo-controlled trial establishes its safety and efficacy.
Chertow
G M
GM
Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Sayegh
M H
MH
Allgren
R L
RL
Lazarus
J M
JM
D058186:Acute Kidney Injury / Q000188:drug therapy / Q000401:mortality* / Q000628:therapy*; D000328:Adult; D000704:Analysis of Variance; D009320:Atrial Natriuretic Factor / Q000627:therapeutic use; D015986:Confounding Factors, Epidemiologic; D004232:Diuretics / Q000627:therapeutic use; D004298:Dopamine / Q000008:administration & dosage* / Q000009:adverse effects*; D004347:Drug Interactions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D010446:Peptide Fragments / Q000627:therapeutic use; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic; D006435:Renal Dialysis; D012306:Risk; D016019:Survival Analysis; D016896:Treatment Outcome
D004232:Diuretics; D010446:Peptide Fragments; D009320:Atrial Natriuretic Factor; C044120:atrial natriuretic factor prohormone (8-33); D004298:Dopamine