Effect of dopamine on renal function after arteriography in patients with pre-existing renal insufficiency.
Contrast media-induced nephropathy is one of the leading causes of hospital-acquired renal failure, occurring most frequently in patients with pre-existing renal insufficiency. We prospectively studied 55 patients with chronic renal insufficiency (serum creatinine concentration 1.4 to 3.5 mg/dl) who underwent abdominal aortography and arteriography of the lower extremities. The patients were randomized into two groups. Group 1, 28 patients, received dopamine 2.5 mcg/kg beginning 1 hour before arteriography and continuing for 12 hours. Group 2 received an equal volume of saline for the same period of time. Serum creatinine and 12-hour creatinine clearance were measured before arteriography and for 4 consecutive days afterward. Acute contrast-induced decrease in renal function was defined as increase in the baseline serum creatinine concentration > or = 0.5 mg/dl. On day 1 postarteriography the serum creatinine increased from baseline .193 mg/dl for controls while the dopamine group decreased slightly from baseline .018 mg/dl (p = 0.002). Excepting day 1 postarteriography, there was no statistical difference between groups, and serum levels for both groups increased linearly from baseline across time (dopamine p = 0.028, control p = 0.025). In patients with pre-arteriography baseline serum levels greater than or equal to 2.0 mg/dl, however, the increase in serum creatinine from baseline levels was consistently and significantly greater in the control group through the fourth day (0.012 < or = p < or = 0.049). Creatinine clearance did not change significantly from baseline after arteriography in the dopamine group (baseline versus days 1 through 4, 0.238 < or = p < or = 0.968); however, the control group showed a significant linear decrease in creatinine clearance from baseline through the fourth day after arteriography (p = 0.016). Dopamine infusion prevented a rise in serum creatinine 24 hours after angiography in patients with pre-existing renal insufficiency, and protected against contrast-induced decrease in renal function in patients whose baseline serum creatinine was > or = 2.0 mg/dl.
Hans
S S
SS
Department of Surgery, Macomb Hospital Center, Warren, Michigan, USA.
Hans
B A
BA
Dhillon
R
R
Dmuchowski
C
C
Glover
J
J
D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D001027:Aortography; D003287:Contrast Media / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood; D004298:Dopamine / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007668:Kidney / Q000098:blood supply; D007676:Kidney Failure, Chronic / Q000139:chemically induced* / Q000175:diagnosis / Q000517:prevention & control; D007677:Kidney Function Tests; D007866:Leg / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D011292:Premedication; D011446:Prospective Studies; D014655:Vascular Resistance / Q000187:drug effects
D003287:Contrast Media; D003404:Creatinine; D004298:Dopamine