Effects of low-dose dopamine on urine output in oliguric, critically ill, renal transplant patients.
Low-dose dopamine (LD-DA) has been used extensively to increase urine output (UO) in critically ill patients. These effects have recently been documented in patients with normal and mildly abnormal renal function. The purpose of this study was to quantitate the effects of LD-DA on UO and urineNa (UNa) excretion in renal transplant (RT) patients, and thereby evaluate the effects of LD-DA on the denervated kidney.


METHODS
Five RT patients and 7 non-transplant controls, hospitalized in the surgical intensive care unit (SICU), with serum creatinine (serum Cr) < 2 mg/dL who were oliguric (UO < 0.5 mL/kg/h), received LD-DA (2.5 micrograms/kg/min). None received other diuretics within 12 h, and all had pulmonary artery occlusion pressure (PAOP) > 10 mmHg and CI > 3.0 L/min/m2. UO was measured hourly and averaged for 2 h pre and 6 h during LD-DA. All data are mean +/- SD.


RESULTS
APACHE II (14 +/- 4), CI (4.1 +/- 1.2 L/min/m2), PAOP (15 +/- 4 mmHg), HR (98 +/- 16/min), and MAP (83 +/- 10 mmHg) were similar between groups and did not change during LD-DA therapy. Initial serum Cr in the RT group (1.6 +/- 0.4 mg/dL) was greater than that in controls (0.9 +/- 0.24 mg/dL), p < 0.05. Initial UO [0.26 +/- 0.10 mL/kg/h (RT) and 0.31 +/- 0.12 mL/kg/h (controls)] and initial UNa [8 +/- 62 meq/L (RT) and 54 +/- 28 meq/L (controls)] were not different. Urine output increased significantly compared with baseline in both groups [final UO 0.55 +/- 0.14 mL/kg/h (RT) and 0.96 +/- 0.41 mL/kg/h (controls)]. Final UNa [72 +/- 37 meq/L (RT) and 99 +/- 56 meq/L (controls)] were not different from each other or from baseline.


CONCLUSIONS
LD-DA increases UO, but not UNa excretion, in RT patients with oliguria, comparably to controls. These data suggest that this effect is predominantly mediated by dopaminergic receptors, since the transplanted kidney is denervated and there were no significant associated changes in hemodynamic parameters during the study.
Flancbaum
L
L
Department of Surgery, Ohio State University, Columbus 43210, USA. Flancbaum.1@osu.edu
Dick
M
M
Choban
P S
PS
Dasta
J P
JP
D003404:Creatinine / Q000652:urine; D016638:Critical Illness; D004298:Dopamine / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009846:Oliguria / Q000188:drug therapy*; D014554:Urination / Q000187:drug effects*
D003404:Creatinine; D004298:Dopamine