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CRITICAL CARE ISSUES FOR THE NEPHROLOGIST: Low‐dose Dopamine in the Intensive Care Unit
Author(s) -
Karthik Swaminathan,
Lisbon Alan
Publication year - 2006
Publication title -
seminars in dialysis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.899
H-Index - 78
eISSN - 1525-139X
pISSN - 0894-0959
DOI - 10.1111/j.1525-139x.2006.00208.x
Subject(s) - medicine , intensive care medicine , intensive care unit , sepsis , adverse effect , dialysis , renal function
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 improving renal function. There are multiple reasons for this lack of efficacy. While dopamine does cause a diuretic effect, it does very little to improve mortality, creatinine clearance, or the incidence of dialysis. Evidence is also growing of its adverse effects on the immune, endocrine, and respiratory systems. It may also potentially increase mortality in sepsis. It is the opinion of the authors that the practice of using low‐dose dopamine should be abandoned. Other drugs and treatment modalities need to be explored to address the serious issue of renal failure in the ICU.