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Ann Intern Med. 2005 Apr 5;142(7):510-24.

Meta-analysis: low-dose dopamine increases urine output but does not prevent renal dysfunction or death.

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  • 1St. Michael's Hospital, Sunnybrook and Women's College Health Sciences Centre, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada. j.friedrich@utoronto.ca

Abstract

BACKGROUND:

Surveys have documented the continued popularity of low-dose dopamine to influence renal dysfunction even though few data support it and editorials and reviews have discouraged its use.

PURPOSE:

To evaluate the effects of low-dose dopamine (< or =5 microg/kg of body weight per minute) compared with placebo or no therapy in patients with or at risk for acute renal failure.

DATA SOURCES:

MEDLINE (1966-January 2005), EMBASE (1980-week 5, 2005), CANCERLIT (1975-2002), CINAHL (1982-January 2005), and CENTRAL (The Cochrane Library, fourth quarter, 2004); bibliographies of retrieved publications; and additional information from 50 trials.

STUDY SELECTION:

Two reviewers independently selected parallel-group randomized and quasi-randomized controlled trials of low-dose dopamine versus control.

DATA EXTRACTION:

Study methods, clinical and renal physiologic outcomes, and adverse events (arrhythmias and myocardial, limb, and cutaneous ischemia) were extracted.

DATA SYNTHESIS:

61 trials that randomly assigned 3359 patients were identified. Meta-analyses using random-effects models showed no effect of low-dose dopamine on mortality (relative risk, 0.96 [95% CI, 0.78 to 1.19]), need for renal replacement therapy (relative risk, 0.93 [CI, 0.76 to 1.15]), or adverse events (relative risk, 1.13 [CI, 0.90 to 1.41]). Low-dose dopamine increased urine output by 24% (CI, 14% to 35%) on day 1. Improvements in serum creatinine level (4% relative decrease [CI, 1% to 7%]) and measured creatinine clearance (6% relative increase [CI, 1% to 11%]) on day 1 were clinically insignificant. There were no significant changes on days 2 and 3 of therapy.

LIMITATIONS:

Statistically significant between-study heterogeneity in physiologic but not clinical outcomes was unexplained by prespecified hypotheses.

CONCLUSION:

Low-dose dopamine offers transient improvements in renal physiology, but no good evidence shows that it offers important clinical benefits to patients with or at risk for acute renal failure.

PMID:
15809463
[PubMed - indexed for MEDLINE]
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