[Renal-protective dose of dopamine: myth or reality?].
Low dose dopamine is widely used to improve diuresis and renal function. This practice is defended by some and fought by others. Acute renal failure in the ICU is often due to tubular necrosis and is a predictor of worse prognosis. Dopamine at low doses is a delta agonist and stimulation of these receptors leads to diuresis and natriuresis. This natriuresis requires additional ATP consumption by the kidney. Low dose dopamine has also systemic hemodynamic effects and these effects can't be dissociated from direct renal effects. Clinical studies of systematic dopamine use in selected high risk patients fail to show a benefit, and side effects of catecholamine administration may lead to additional cardiovascular morbidity. We conclude that low dose dopamine has a demonstrated renal effect but its systematic use to prevent or treat a renal failure cannot be warranted.
de Werra
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P
Service des soins intensifs, Hôpital régional de Sion.
Bracco
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D
D058186:Acute Kidney Injury / Q000188:drug therapy*; D002316:Cardiotonic Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D004232:Diuretics / Q000008:administration & dosage* / Q000009:adverse effects*; D004298:Dopamine / Q000008:administration & dosage* / Q000009:adverse effects*; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007668:Kidney / Q000187:drug effects*; D018579:Patient Selection; D011379:Prognosis; D012307:Risk Factors
D002316:Cardiotonic Agents; D004232:Diuretics; D004298:Dopamine