Renal dose Dopamine question.

rstewart........beautiful.

We use dopamine a lot in CCU, and almost never is a renal perfusion dose an issue. All our renal attendants will look you in the eye and say there is no such thing as a renal dose of dopamine, it just doesn't exist. For doseages under 5 mcg, it's time to wean them off, and fix their perfusion problems through other methods. I guess we are lucky where I work, no patient goes to the floor on any IV vasopressor or vasodilator.

Got to agree with rstewart.

The research does not support renal dose dopmaine. Increased urine output does not mean increased renal function. Research has shown over the long term, there has been no improvement in renal function due to renal dose dopmaine. Basically, no reduction in number of patients who have renal failure. Despite this it is still used in this fashion. Sad that the healthcare world cannot accept evidence-base practice or evidence based medicine as a standard on which to provide clinical care. Just my two cents.

Hmmm...interesting information. Now i must look and research this topic. I have not heard this about renal dose dopamine. Our facility uses 2-4mcq/kg/min. I don't remember how many times i have administered it. BTW i am in ER. Interesting though, thanks for the info.

3mcg/kg/minute

renerian

rstewart - stated so well!

Strange how we hang onto treatment ideas because 'that is what is always done' even after valid research. I work with docs who do both! It's up to us, the nurses, to tactfully initiate conversation that may drive them to check out the newest use of drugs/treatments.

Yep, these drugs can be dangerous but the hospitals have a self-serving interest (money/staffing) on why suddenly they are allowed on step down units where today you have 6 patients to monitor and yesterday in was 2! Yeah that safe and in the best interest of the patients! NOT!

Read the literature - the concept of "renal dose dopamine" was overturned some time back. I doubt even the product literature mentions it anymore. We mostly use Noradrenaline for BP management and virtually never use dopamine.

Anyone using fenoldopam?

I have been amazed that the knowledge related to dopamine has been known for some time. But, the ancient doctors hold onto it anyway! I don't understand, if I was a nephrologist, why would I continue to do something I know isn't helpful. It is very frustrating. We even had a patient who was turning purple/blue in her extremities from the dopamine, but the doctor was only concerned with what her bp was!!!! Wish we had more of a voice over these washed-up, has-been docs.(never fails, they are always on the hospital board and think they are GOD)

You say Psycho like its a bad thing.

http://fenoldopam.com/ArticleSummaries.asp

Have only read some literature that mentions it.

Thanks for all the replys. I am going to copy these replies and present them at our next unit meeting for a start.

Originally posted by JWRN

Got to agree with rstewart.

 

The research does not support renal dose dopmaine. Increased urine output does not mean increased renal function. Research has shown over the long term, there has been no improvement in renal function due to renal dose dopmaine. Basically, no reduction in number of patients who have renal failure. Despite this it is still used in this fashion. Sad that the healthcare world cannot accept evidence-base practice or evidence based medicine as a standard on which to provide clinical care. Just my two cents.

I realize that this is an old thread by now, but I was talking to one of our nephrologists the other day. He's very much into evidence-based practice, research, teaching, etc. I ask him his opionion on the use of renal dose dopamine. Here's what he had to say in a nutshell...

According to the research and any reproducable studies, renal dose dopamine does not work to improve renal function. In fact, as has been pointed out, if the kidneys have an inherent filtering problem, no amount of urine output will affect this -- that is, water removal does not equal waste removal. However, there is a very small population of people in which renal dosing does improve renal perfusion and urine output -- a small enough population that it won't shift a large-scale study to the positive. Again, urine output does not equal or improve renal function.

Occasionally he does order renal dopamine for the purpose of helping diuresis. He usually orders it as a test, and if urine output improves he sticks with it; if output doesn't improve we stop it. If the kidneys are filtering normally than it will help filter, if the kidneys aren't filtering properly then renal dopamine won't improve waste removal, but might help in diuresis.