Low-dose dopamine in patients with early renal dysfunction

Low-dose dopamine in patients with early renal dysfunction: a placebo-controlled randomised trial.

Anzics Clinical Trials Group,                                                                                                                                               Lancet 2000; 356:2139-43

Australian and New Zealand Intensive Care Society (ANZICS) Clinical Trials Group. Allison Burger, Executive Officer, ANZICS House, 233 Rathdowne Street, Carlton, Victoria 3503, Australia

BACKGROUND: Low-dose dopamine is commonly administered to critically ill patients in the belief that it reduces the risk of renal failure by increasing renal blood flow. However, these effects have not been established in a large randomised controlled trial, and use of dopamine remains controversial. We have done a multicentre, randomised, double-blind, placebo-controlled study of low-dose dopamine in patients with at least two criteria for the systemic inflammatory response syndrome and clinical evidence of early renal dysfunction (oliguria or increase in serum creatinine concentration).
METHODS: 328 patients admitted to 23 participating intensive-care units (ICUs) were randomly assigned a continuous intravenous infusion of low-dose dopamine (2 µg kg-1 min-1) or placebo administered through a central venous catheter while in the ICU. The primary endpoint was the peak serum creatinine concentration during the infusion. Analyses excluded four patients with major protocol violations.
FINDINGS: The groups assigned dopamine (n=161) and placebo (n=163) were similar in terms of baseline characteristics, renal function, and duration of trial infusion. There was no difference between the dopamine and placebo groups in peak serum creatinine concentration during treatment (245 [SD 144] vs 249 [147] µmol/L; p=0·93), in the increase from baseline to highest value during treatment (62 [107] vs 66 [108] µmol/L; p=0·82), or in the numbers of patients whose serum creatinine concentration exceeded 300 µmol/L (56 vs 56; p=0·92) or who required renal replacement therapy (35 vs 40; p=0·55). Durations of ICU stay (13 [14] vs 14 [15] days; p=0·67) and of hospital stay (29 [27] vs 33 [39] days; p=0·29) were also similar. There were 69 deaths in the dopamine group and 66 in the placebo group.
INTERPRETATION: Administration of low-dose dopamine by continuous intravenous infusion to critically ill patients at risk of renal failure does not confer clinically significant protection from renal dysfunction.