Low-dose dopamine in the intensive care unit.
For much of the last four decades, low-dose dopamine has been considered the drug of choice to treat and prevent renal failure in the intensive care unit (ICU). The multifactorial etiology of renal failure in the ICU and the presence of coexisting multisystem organ dysfunction make the design and execution of clinical trials to study this problem difficult. However, in the last decade, several meta-analyses and one large randomized trial have all shown a lack of benefit of low-dose dopamine in improving renal function. There are multiple reasons for this lack of efficacy. While dopamine does cause a diuretic effect, it does very little to improve mortality, creatinine clearance, or the incidence of dialysis. Evidence is also growing of its adverse effects on the immune, endocrine, and respiratory systems. It may also potentially increase mortality in sepsis. It is the opinion of the authors that the practice of using low-dose dopamine should be abandoned. Other drugs and treatment modalities need to be explored to address the serious issue of renal failure in the ICU.
Karthik
Swaminathan
S
Department of Anaesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts 02215, USA.
Lisbon
Alan
A
D058186:Acute Kidney Injury / Q000150:complications / Q000188:drug therapy*; D001145:Arrhythmias, Cardiac / Q000139:chemically induced; D002986:Clinical Trials as Topic; D004231:Diuresis / Q000187:drug effects; D004298:Dopamine / Q000008:administration & dosage* / Q000009:adverse effects* / Q000493:pharmacokinetics; D015259:Dopamine Agents / Q000008:administration & dosage* / Q000009:adverse effects* / Q000493:pharmacokinetics; D004305:Dose-Response Relationship, Drug; D041981:Gastrointestinal Tract / Q000098:blood supply / Q000187:drug effects; D006801:Humans; D000860:Hypoxia / Q000139:chemically induced; D007362:Intensive Care Units / Q000639:trends; D007511:Ischemia / Q000139:chemically induced; D007668:Kidney / Q000187:drug effects / Q000378:metabolism / Q000503:physiopathology; D018805:Sepsis / Q000209:etiology / Q000401:mortality
D015259:Dopamine Agents; D004298:Dopamine