Low-dose dopamine: a physiologically based review.
BACKGROUND
In an attempt to prevent or alter the course of acute renal failure, many surgeons continue to use low-dose dopamine. This article critically reviews the physiologic reasons why low-dose dopamine is not clinically efficacious.


METHODS
A critical review of English language literature.


RESULTS
The effect of dopamine on renal blood flow remains controversial. If dopamine does increase renal blood flow, the vascular anatomy of the kidney would limit its effectiveness. Rather than improving renal function, dopamine has been shown to impair renal oxygen kinetics, inhibit feedback systems that protect the kidney from ischemia, and may worsen tubular injury. Dopamine has not been proven useful in the prevention or alteration of the course of acute renal failure as a result of heart failure, cardiac surgery, abdominal aortic surgery, sepsis, and transplantation. Dopamine has been associated with multiple complications involving the cardiovascular, pulmonary, gastrointestinal, endocrine, and immune systems.


CONCLUSIONS
Based on the anatomy and physiology of the kidney, low-dose dopamine would not be expected to improve renal failure and this has been demonstrated by the lack of efficacy in clinical trials.
Schenarts
Paul J
PJ
The Center of Excellence in Trauma and Surgical Critical Care, University Health Systems of Eastern Carolina, Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, North Carolina 27858-4354, USA. pschenar@pcmh.com
Sagraves
Scott G
SG
Bard
Michael R
MR
Toschlog
Eric A
EA
Goettler
Claudia E
CE
Newell
Mark A
MA
Rotondo
Michael F
MF
D058186:Acute Kidney Injury / Q000517:prevention & control*; D006348:Cardiac Surgical Procedures; D002316:Cardiotonic Agents / Q000008:administration & dosage* / Q000493:pharmacokinetics; D016638:Critical Illness; D004298:Dopamine / Q000008:administration & dosage* / Q000493:pharmacokinetics; D004305:Dose-Response Relationship, Drug; D004734:Energy Metabolism; D006801:Humans; D007668:Kidney / Q000098:blood supply* / Q000378:metabolism / Q000502:physiology; D016030:Kidney Transplantation; D010100:Oxygen / Q000378:metabolism; D012039:Regional Blood Flow / Q000187:drug effects*
D002316:Cardiotonic Agents; D010100:Oxygen; D004298:Dopamine