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

  1. by   mady
    In 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.
    For 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,