[Is preventive perioperative dopamine administration of value?].

Dopamine interacts in a dose dependent manner with three types of receptors: the alpha- and beta-adrenoceptors and specific dopaminergic receptors. Hence dopamine can exert direct and indirect renal effects. Stimulation of myocardial beta 1-receptors causes an increase in cardiac output and a subsequent augmentation of renal blood flow. However, a major role of selective renal vasodilation in response to dopamine has been brought into question by recent studies. In addition, dopamine has been shown to decrease tubular transport of sodium and to produce sodium diuresis. This natriuresis may induce volume depletion with further deterioration of renal function. Expectations that low-dose dopamine could have a renal-sparing potential did not prove true. Prophylactic infusion of low-dose dopamine in patients undergoing aortic surgery, orthotopic liver grafting or renal transplantation failed to show a renal protective effect or an improved clinical outcome. The routine use of "renal-dose" dopamine therefore cannot be recommended. More attention must be paid to prevent or abolish prerenal causes of renal impairment. Basic measures as volume expansion, care of cardiocirculatory status and close monitoring of renal function are of special importance.