title: Lack of renoprotective effects of dopamine and furosemide during cardiac surgery.
abstract: Because development of acute renal failure is one of the most potent predictors of outcome in cardiac surgery patients, the prevention of renal dysfunction is of utmost importance in perioperative care. In a double-blind randomized controlled trial, the effectiveness of dopamine or furosemide in prevention of renal impairment after cardiac surgery was evaluated. A total of 126 patients with preoperatively normal renal function undergoing elective cardiac surgery received a continuous infusion of either "renal-dose" dopamine (2 microg/kg per min) (group D), furosemide (0.5 microg/kg per min) (group F), or isotonic sodium chloride as placebo (group P), starting at the beginning of surgery and continuing for 48 h or until discharge from the intensive care unit, whichever came first. Renal function parameters and the maximal increase of serum creatinine above baseline value within 48 h (deltaCrea(max)) were determined. The increase in plasma creatinine was twice as high in group F as in groups D and P (P < 0.01). Acute renal injury (defined as deltaCreamax) >0.5 mg/dl) occurred more frequently in group F (six of 41 patients) than in group D (one of 42) and group P (zero of 40) (P < 0.01). (The difference between group D and group P was not significant.) Creatinine clearance was lower in group F (P < 0.05). Two patients in group F required renal replacement therapy. The mean volume of infused fluids, blood urea nitrogen, serum sodium, serum potassium, and osmolar- and free-water clearance was similar in all groups. It was shown that continuous infusion of dopamine for renal protection was ineffective and was not superior to placebo in preventing postoperative dysfunction after cardiac surgery. In contrast, continuous infusion of furosemide was associated with the highest rate of renal impairment. Thus, renaldose dopamine is ineffective and furosemide is even detrimental in the protection of renal dysfunction after cardiac surgery.
authors.affiliation: Department of Cardiothoracic and Vascular Anesthesia and Intensive Care, Division of Nephrology, University Clinic of Vienna, Austria.
authors.forename: Andrea
authors.initials: A
authors.lastname: Lassnigg
authors.affiliation: Department of Cardiothoracic and Vascular Anesthesia and Intensive Care, Division of Nephrology, University Clinic of Vienna, Austria.
authors.forename: Eva
authors.initials: E
authors.lastname: Donner
authors.affiliation: Department of Cardiothoracic and Vascular Anesthesia and Intensive Care, Division of Nephrology, University Clinic of Vienna, Austria.
authors.forename: Georg
authors.initials: G
authors.lastname: Grubhofer
authors.affiliation: Department of Internal Medicine I, Division of Nephrology, University Clinic of Vienna, Austria.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Presterl
authors.affiliation: Department of Internal Medicine III, Division of Nephrology, University Clinic of Vienna, Austria.
authors.forename: Wilfred
authors.initials: W
authors.lastname: Druml
authors.affiliation: Department of Cardiothoracic and Vascular Anesthesia and Intensive Care, Division of Nephrology, University Clinic of Vienna, Austria.
authors.forename: Michael
authors.initials: M
authors.lastname: Hiesmayr
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology / Q000517:prevention & control*; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002316:Cardiotonic Agents / Q000008:administration & dosage*; D004232:Diuretics / Q000008:administration & dosage*; D004298:Dopamine / Q000008:administration & dosage*; D004311:Double-Blind Method; D005260:Female; D005665:Furosemide / Q000008:administration & dosage*; D006801:Humans; D007262:Infusions, Intravenous; D007432:Intraoperative Period; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D012016:Reference Values; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D002316:Cardiotonic Agents; D004232:Diuretics; D005665:Furosemide; D004298:Dopamine