The physiologic effects of low-dose dopamine on renal blood flow and urine output have led to the widespread use of this medication to prevent and treat acute renal failure. In recent years, however, this practice has been called into question after randomized controlled trials found no evidence of clinical benefit. Nevertheless, many physicians continue to administer low-dose dopamine (e.g., 5 mcg or less per kg of body weight per minute) to patients at high risk for acute renal failure. Friedrich and colleagues performed a systematic review and meta-analysis to determine whether low-dose dopamine had any benefit on clinical outcomes.
Sixty-one controlled trials comparing low-dose dopamine to placebo or no treatment met inclusion criteria, which required data on at least one of the following outcomes: all-cause mortality, adverse events such as cardiac arrhythmias and vascular or cutaneous ischemia, requirement for renal replacement therapy, or renal physiologic parameters such as urine output. Studies that used other medications such as mannitol (Osmitrol) or other diuretics were included if the medications were given equally to the dopamine and control groups. Although study size ranged from 12 to 347 patients, only five studies had more than 100 participants. Populations included candidates for cardiac, vascular, and transplant surgery; patients receiving intravenous contrast media; and neonates.
In pooled analyses, the administration of low-dose dopamine had no effect on all-cause mortality (relative risk [RR], 0.96; 95% confidence interval [CI], 0.78 to 1.19), the need for renal replacement therapy (RR, 0.93; 95% CI, 0.76 to 1.15), or adverse events (RR, 1.13; 95% CI, 0.90 to 1.41). The only statistically significant effects associated with low-dose dopamine were increases in urine output and creatinine clearance during the first day after initiation of therapy.
The authors conclude that administering low-dose dopamine to patients at risk for acute renal failure has no effect on clinical outcomes and does not increase adverse effects. The authors suggest that, in light of these findings, the use of low-dose dopamine in patients with renal failure will remain controversial.