The use of diuretics and dopamine in acute renal failure: a systematic review of the evidence.

OBJECTIVE

To evaluate the impact of diuretics and dopamine for both the prevention and treatment of renal dysfunction in the acute care setting. STUDY IDENTIFICATION AND SELECTION: Studies were identified via MEDLINE, and through bibliographies of primary and review articles. Articles were then screened by the author for studies addressing the use of diuretics or dopamine in the prevention and/or treatment of renal dysfunction. DATA ABSTRACTION AND LITERATURE APPRAISAL: From individual studies, data were abstracted regarding design features, population, intervention and outcomes. Studies were graded by levels according to their design. RESULTS: A total of 10 studies using diuretics and 30 involving dopamine were identified. Level I evidence exists against the use of diuretics for radiocontrast-induced acute tubular necrosis, and loop diuretics given after vascular surgery. There is level II evidence that diuretics do not improve outcome in patients with established acute renal failure. Level II evidence also exists against the use of dopamine in the prevention of acute tubular necrosis in multiple subsets of patients. CONCLUSIONS: Routine use of diuretics or dopamine for the prevention of acute renal failure cannot be justified on the basis of available evidence.