Renal dose Dopamine question. - page 3
What is considered a renal dose for Dopamine on your floor? On our surgical unit, our standard is 5mcg/kg/min. I have heard this is just a little higher than some others. How about where you work?... Read More
May 11, '03In many australian hosptial renal dose of dopamine is 3mcg/kg/min. Titration is absolutly no no on genral ward. Renal dose of dopamine is Only used to increase uinary output on the floor. It is not for cardiac managment, such as hypotension.
May 12, '03For a decade or more many people have urged caution with dopamine. The most
recent such editorial was entitled 'Renal dose dopamine: long on conjecture,
short on fact' by H.L. Corwin and A. Lisbon, Crit Care Med, 2000,
28:1657-1658. The popularity of dopamine stems from uncontrolled studies in
the 70s and 80s demonstrating natriuresis and diuresis, leading to the
conjecture that this might be nephroprotective. No prospective randomised
study has demonstrated this. The most recent paper I have seen is Ichai C.
et al, CCM, 2000, 28:1329-1335, to which the above editorial related. This
group looked at a total of EIGHT patients in a crossover fashion, and only
demonstrated a transient diuresis and increase in creatinine clearance and
FeNa, maximal at eight hours but the effect was lost by 48 hours. I
surprised that a negative paper describing only eight patients ever got
published, but this is the quality of the dopamine literature.
The Australian and New Zealand Intensive Care Society (ANZICS) Clinical
Trials Group has looked at dopamine in a large multicentre double blinded
placebo controlled prospective trial of over 700 patients. No difference was
found between dopamine and saline at two interim analyses, looking at
creatinine (peak or increase), incidence of renal failure, days of
ventilation, ICU or hospital length of stay, and ICU or hospital mortality.
The final study has been adequately powered to make a false negative
unlikely, and will be published this year in the Lancet.
Have a look also at Kellum JA and Bellomo R, Low dose dopamine: what
benefit?, CCM, 2000, 28:907-908. Bellomo was one the principle investigators
in the ANZICS trial.
In the absence of any good evidence supporting the use of dopamine, and the
well known neurohumoral and splanchnic adverse effects, it is hard to
justify the continuing use of dopamine in the ICU,