title: Comparison of systemic and renal effects of dopexamine and dopamine in norepinephrine-treated septic shock.
abstract: OBJECTIVE
  Vasopressor-induced vasoconstriction may compromise renal and splanchnic blood flow in patients with septic shock, resulting in secondary organ failures. The authors compared the effects of the vasodilatatory agent dopexamine against renal-dose dopamine and placebo in patients with norepinephrine therapy and septic shock, using 24-hour serum creatinine clearance (C(crea)) as a major endpoint. The primary hypothesis to be tested was that dopexamine is more effective than dopamine and that dopamine shows better effects than placebo regarding organ failures and C(crea).
  
  
  METHODS
  A prospective, randomized, controlled, double-blinded study.
  
  
  METHODS
  Intensive care unit in a tertiary care university hospital.
  
  
  METHODS
  Sixty-one patients with septic shock defined according to established criteria.
  
  
  METHODS
  Patients received either dopexamine (2 microg/kg/min, n = 20), dopamine (3 microg/kg/min, n = 21), or placebo (n = 20).
  
  
  RESULTS
  The trial groups were similar in terms of baseline characteristics. The authors found no significant differences among the dopexamine, dopamine, and placebo groups with regard to a comprehensive number of renal function parameters including C(crea) and organ-failure scores. There was a significant increase in heart rate after dopexamine infusion; other hemodynamic parameters remained unchanged in the dopexamine group. In a post hoc analysis that included only patients with renal impairment at study inclusion (n = 28), patients who received dopamine showed significant improvements in C(crea) when compared with placebo. Dopexamine was not effective in this subgroup.
  
  
  CONCLUSIONS
  Dopexamine is no more effective than dopamine or placebo regarding renal function in patients with septic shock requiring norepinephrine. Both therapies do not influence organ-failure scores.
authors.affiliation: Department of Anesthesiology, Ludwig-Maximilians University, Munich, Germany. martin.schmoelz@med.uni-muenchen.de
authors.forename: Martin
authors.initials: M
authors.lastname: Schmoelz
authors.forename: Gustav
authors.initials: G
authors.lastname: Schelling
authors.forename: Martin
authors.initials: M
authors.lastname: Dunker
authors.forename: Michael
authors.initials: M
authors.lastname: Irlbeck
mesh_terms: D000316:Adrenergic alpha-Agonists / Q000627:therapeutic use; D002316:Cardiotonic Agents / Q000627:therapeutic use; D003401:Creatine / Q000097:blood*; D004298:Dopamine / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D018491:Dopamine Agonists / Q000627:therapeutic use; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007668:Kidney / Q000187:drug effects* / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000627:therapeutic use*; D011446:Prospective Studies; D012772:Shock, Septic / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D016896:Treatment Outcome; D014661:Vasoconstriction / Q000187:drug effects* / Q000502:physiology
chemical_list: D000316:Adrenergic alpha-Agonists; D002316:Cardiotonic Agents; D018491:Dopamine Agonists; C046318:dopexamine; D003401:Creatine; D004298:Dopamine; D009638:Norepinephrine