The benefit of low-dose dopamine during vigorous diuresis for congestive heart failure associated with renal insufficiency: does it protect renal function?

BACKGROUND

Low-dose dopamine, a renal vasodilator, has been used empirically to improve renal function or outcome in critically ill patients with oliguria or acute renal failure.

HYPOTHESIS

This study was designed to investigate the efficacy of low-dose dopamine (2 micrograms/kg/min) as a renal-protective agent during vigorous diuresis for congestive heart failure (CHF) associated with mild or moderate renal insufficiency.

METHODS

Of 20 study patients (mean age 74.3 +/- 15 years) with severe CHF, 10 (Group A) were randomized to a treatment strategy of intravenous bumetanide (1 mg b.i.d.) alone and another 10 (Group B) to low-dose dopamine and a similar diuretic regimen for a duration of 5 days or less if clinical edema remitted.

RESULTS

Group B patients showed a significant improvement in renal function and urinary output: serum blood urea nitrogen 48.9 +/- 10.3 to 32.1 +/- 14.4 mg/dl (p < 0.05); serum creatinine 1.97 +/- 0.24 to 1.49 +/- 0.39 mg/dl (p < 0.05); creatinine clearance 35.6 +/- 11.6 to 48.8 +/- 12.3 ml/min (p < 0.05); and indexed urinary output 0.56 +/- 0.16 to 2.02 +/- 0.72 ml/kg/h (p < 0.05). Group A patients showed a significant increase in urinary output but nonsignificant renal functional deterioration.

CONCLUSION

The renal-protective effect of low-dose dopamine in the setting of CHF and vigorous diuresis is supported by this study.