Impact of dopamine infusion on renal function in hospitalized heart failure patients: results of the Dopamine in Acute Decompensated Heart Failure (DAD-HF) Trial.
BACKGROUND
Worsening renal function (WRF) and hypokalemia related to diuretic use for acute decompensated heart failure (ADHF) are common and associated with poor prognosis. Low-dose dopamine infusion improves renal perfusion; its effect on diuresis or renal function specifically in ADHF is not known.


RESULTS
Sixty consecutive ADHF patients (age 75.7 ± 11.2 years; 51.7% female; left ventricular ejection fraction 35.3 ± 12.1%) were randomized, after receiving a 40 mg intravenous furosemide bolus, to either high-dose furosemide (HDF, 20 mg/h continuous infusion for 8 hours) or low-dose furosemide combined with low-dose dopamine (LDFD, furosemide 5 mg/h plus dopamine 5 μg kg(-1) min(-1) continuous infusion for 8 hours). Both strategies were compared for total diuresis, WRF (defined as a rise in serum creatinine of >0.3 mg/dL from baseline to 24 hours), electrolyte balance, and 60-day postdischarge outcomes. Mean hourly excreted urine volume (272 ± 149 mL in HDF vs 278 ± 186 mL in LDFD group; P = .965) and changes in dyspnea score (Borg index: -4.4 ± 2.1 in HDF group vs -4.7 ± 2.0 in LDFD group; P = .575) during the 8 hours of protocol treatment were similar in the two groups. WRF was more frequent in the HDF (n = 9; 30%) than in the LDFD group (n = 2; 6.7%; P = .042). Serum potassium changed from 4.3 ± 0.5 to 3.9 ± 0.4 mEq/L at 24 hours (P = .003) in the HDF group and from 4.4 ± 0.5 to 4.2 ± 0.5 mEq/L at 24 hours (P = .07) in the LDFD group. Length of stay and 60-day mortality or rehospitalization rates (all-cause, cardiovascular, and worsening HF) were similar in the two groups.


CONCLUSIONS
In ADHF patients, the combination of low-dose furosemide and low-dose dopamine is equally effective as high-dose furosemide but associated with improved renal function profile and potassium homeostasis.
Department of Cardiology, Larissa University Hospital, Larissa, Greece.
Gregory
G
Giamouzis
Javed
J
Butler
Randall C
RC
Starling
George
G
Karayannis
John
J
Nastas
Charalambos
C
Parisis
Dimitrios
D
Rovithis
Dimitrios
D
Economou
Konstantinos
K
Savvatis
Themistoklis
T
Kirlidis
Themistoklis
T
Tsaknakis
John
J
Skoularigis
Dirk
D
Westermann
Carsten
C
Tschöpe
Filippos
F
Triposkiadis
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D004298:Dopamine / Q000008:administration & dosage*; D004311:Double-Blind Method; D005260:Female; D005665:Furosemide / Q000008:administration & dosage; D006333:Heart Failure / Q000188:drug therapy* / Q000503:physiopathology; D006760:Hospitalization / Q000639:trends; D006801:Humans; D007262:Infusions, Intravenous; D007668:Kidney / Q000187:drug effects* / Q000502:physiology*; D007677:Kidney Function Tests / Q000639:trends; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
D005665:Furosemide; D004298:Dopamine