Low dose dopamine infusion reduces renal tubular injury following cardiopulmonary bypass surgery.
BACKGROUND
The use of dopamine to protect the kidneys against hypoperfusion injury remains controversial with little clinical evidence of benefit and increasing concerns regarding safety. In this double-blind, prospective, randomised study, we investigated the effect of dopamine infusion (2.5 microg/kg/min) on glomerular filtration rate (GFR) and tubular injury in patients undergoing routine cardiopulmonary bypass (CPB).


METHODS
Forty eight patients were randomly assigned to receive intravenous dopamine or saline from induction of anaesthesia until 48 hours post-operatively. There were no differences in mean age, bypass time or pre-op creatinine in the 36 patients (33 men) who completed the study. 51Cr-EDTA GFR (ml/min/1.73 m2) was measured pre-operatively and on day 5 only. Urinary markers of tubular injury (albumin, N-acetyl glucosaminidase, NAG; retinol binding protein, RBP) were measured pre-operatively, and on days 1, 2 and 5.


RESULTS
GFR was preserved equally in both groups. All patients demonstrated significant tubular injury but urinary levels of NAG and RBP were lower in the dopamine group (41%, p=0.057 and 41%, p=0.007, respectively) on the first post-operative day.


CONCLUSIONS
We conclude that low dose dopamine infusion may reduce renal tubular injury following CPB in patients with normal or near normal baseline renal function.
Sumeray
M
M
Department of Cardiothoracic Surgery, Middlesex Hospital, UCLH Trust, London, UK.
Robertson
C
C
Lapsley
M
M
Bomanji
J
J
Norman
A G
AG
Woolfson
R G
RG
D058186:Acute Kidney Injury / Q000209:etiology / Q000517:prevention & control; D000368:Aged; D002315:Cardiopulmonary Bypass / Q000009:adverse effects* / Q000379:methods; D002316:Cardiotonic Agents / Q000008:administration & dosage*; D003324:Coronary Artery Disease / Q000601:surgery; D004298:Dopamine / Q000008:administration & dosage*; D004311:Double-Blind Method; D005260:Female; D005919:Glomerular Filtration Rate; D006349:Heart Valve Diseases / Q000601:surgery; D006801:Humans; D007262:Infusions, Intravenous; D007684:Kidney Tubules / Q000187:drug effects* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012079:Renal Circulation / Q000187:drug effects*; D016896:Treatment Outcome
D002316:Cardiotonic Agents; D004298:Dopamine