Renal effects of added low-dose dopamine in acute heart failure patients with diuretic resistance to natriuretic peptide.
Worsening renal function during the early phase of hospitalization is related to adverse outcomes in acute heart failure (AHF). This study aimed to clarify whether added low-dose dopamine (DA) is clinically beneficial for AHF patients with diuretic resistance to human atrial natriuretic peptide (hANP). Twenty-four AHF patients, who did not have adequate diuresis by 4 hours after administration of hANP, were randomized to a low dose of DA (1-3 μg·kg·min, n = 12) or a low dose of furosemide (10-30 mg injection, n = 12). The significant increase in mean hourly urine volume from baseline (265% ± 204% with hANP + DA; 187% ± 118% with hANP + furosemide) and improvement of dyspnea were similarly observed in both groups. Significant decreases in serum creatinine levels were observed by -14.0% ± 14.2% in the hANP + DA group compared with the hANP + furosemide group (4.5% ± 9.6%, P = 0.0011) without increases in the renotubular and myocardial markers. The incidence of worsening renal function defined as a rise in serum creatinine of >0.3 mg/dL was not observed within 3 days of admission in both groups. Added low-dose DA might not have a harmful effect on renal function and effects of diuresis and symptom relief without a significant increase in troponin-T in AHF patients with diuretic resistance to hANP.
*Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan; †Department of Internal Medicine and Cardiology, Nippon Medical School, Musashi-Kosugi Hospital, Kanagawa, Japan; and ‡Department of Internal Medicine, Fraternity Memorial Hospital, Tokyo, Japan.
Masataka
M
Kamiya
Naoki
N
Sato
Ayaka
A
Nozaki
Mai
M
Akiya
Hirotake
H
Okazaki
Yasuhiro
Y
Takahashi
Kyoichi
K
Mizuno
Wataru
W
Shimizu
D000368:Aged; D000369:Aged, 80 and over; D009320:Atrial Natriuretic Factor / Q000008:administration & dosage*; D015415:Biomarkers / Q000097:blood; D003404:Creatinine / Q000097:blood; D004231:Diuresis / Q000187:drug effects*; D004232:Diuretics / Q000009:adverse effects / Q000627:therapeutic use*; D004298:Dopamine / Q000008:administration & dosage* / Q000009:adverse effects; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D005260:Female; D005665:Furosemide / Q000008:administration & dosage; D006333:Heart Failure / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007564:Japan; D007668:Kidney / Q000187:drug effects* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D020107:Troponin T / Q000097:blood
D015415:Biomarkers; D004232:Diuretics; D020107:Troponin T; D005665:Furosemide; D009320:Atrial Natriuretic Factor; D003404:Creatinine; D004298:Dopamine