CRITICAL CARE ISSUES FOR THE NEPHROLOGIST: Low‐dose Dopamine in the Intensive Care Unit

@article{Karthik2006CRITICALCI,
  title={CRITICAL CARE ISSUES FOR THE NEPHROLOGIST: Low‐dose Dopamine in the Intensive Care Unit},
  author={Swaminathan Karthik and Alan Lisbon},
  journal={Seminars in Dialysis},
  year={2006},
  volume={19}
}
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… 
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References

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TLDR
The use of low-dose dopamine for the treatment or prevention of acute renal failure cannot be justified on the basis of available evidence and should be eliminated from routine clinical use.
A comparison between fenoldopam and low-dose dopamine in early renal dysfunction of critically ill patients*
TLDR
In critically ill patients, a continuous infusion of fenoldopam at 0.1 &mgr;g/kg/min does not cause any clinically significant hemodynamic impairment and improves renal function compared with renal dose dopamine, and in the setting of acute early renal dysfunction, the attempt to reverse renal hypoperfusion with fen oldopam is more effective than with low-dose dopamine.
Meta-Analysis: Low-Dose Dopamine Increases Urine Output but Does Not Prevent Renal Dysfunction or Death
TLDR
A systematic review and meta-analysis of low-dose dopamine was conducted by using a comprehensive search strategy to determine its effect on a broad range of clinical and renal physiologic outcomes and adverse events.
Lack of renoprotective effects of dopamine and furosemide during cardiac surgery.
TLDR
It was shown that continuous infusion of dopamine for renal protection was ineffective and was not superior to placebo in preventing postoperative dysfunction after cardiac surgery and furosemide was associated with the highest rate of renal impairment.
Physiologic Impact of Low-Dose Dopamine on Renal Function in the Early Post Renal Transplant Period
TLDR
LDD significantly increases ERPF, UFR, CC, and tUNa in the transplanted allograft kidney treated with cyclosporine immunosuppression in the early posttransplant period.
Does dopamine administration in shock influence outcome? Results of the Sepsis Occurrence in Acutely Ill Patients (SOAP) Study*
TLDR
It is suggested that dopamine administration may be associated with increased mortality rates in shock, and there is a need for a prospective study comparing dopamine with other catecholamines in the management of circulatory shock.
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TLDR
Plasma dopamine clearance is lower in critically ill patients and there is a large interindividual variation, therefore it is impossible to predict the plasma level from the infusion rate, and the concept of a selective renovascular low-dose dopamine infusion is invalid in critical ill patients.
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