Article    Table of Contents                    Full Text of this article    PDF of this article (PDFs free after 6 months)    Figures/Tables List  Services    Send comment/rapid response letter    Notify a friend about this article    Alert me when this article is cited    Add to Personal Archive    Download to Citation Manager    ACP Search                            Get Permissions  Google Scholar    Search for Related Content  PubMed Articles in PubMed by Author:    Friedrich, J. O.    Beyene, J.    Related Articles in PubMed    PubMed Citation    PubMed

REVIEW

Meta-Analysis: Low-Dose Dopamine Increases Urine Output but Does Not Prevent Renal Dysfunction or Death

Jan O. Friedrich, MD, DPhil; Neill Adhikari, MD, CM; Margaret S. Herridge, MD, MPH; and Joseph Beyene, PhD

5 April 2005 | Volume 142 Issue 7 | Pages 510-524

Background: Surveys have documented the continued popularity of low-dose dopamine to influence renal dysfunction even though few data support it and editorials and reviews have discouraged its use.

Purpose: To evaluate the effects of low-dose dopamine (5 µg/kg of body weight per minute) compared with placebo or no therapy in patients with or at risk for acute renal failure.

Data Sources: MEDLINE (1966–January 2005), EMBASE (1980–week 5, 2005), CANCERLIT (1975–2002), CINAHL (1982–January 2005), and CENTRAL (The Cochrane Library, fourth quarter, 2004); bibliographies of retrieved publications; and additional information from 50 trials.

Study Selection: Two reviewers independently selected parallel-group randomized and quasi-randomized controlled trials of low-dose dopamine versus control.

Data Extraction: Study methods, clinical and renal physiologic outcomes, and adverse events (arrhythmias and myocardial, limb, and cutaneous ischemia) were extracted.

Data Synthesis: 61 trials that randomly assigned 3359 patients were identified. Meta-analyses using random-effects models showed no effect of low-dose dopamine on mortality (relative risk, 0.96 [95% CI, 0.78 to 1.19]), need for renal replacement therapy (relative risk, 0.93 [CI, 0.76 to 1.15]), or adverse events (relative risk, 1.13 [CI, 0.90 to 1.41]). Low-dose dopamine increased urine output by 24% (CI, 14% to 35%) on day 1. Improvements in serum creatinine level (4% relative decrease [CI, 1% to 7%]) and measured creatinine clearance (6% relative increase [CI, 1% to 11%]) on day 1 were clinically insignificant. There were no significant changes on days 2 and 3 of therapy.

Limitations: Statistically significant between-study heterogeneity in physiologic but not clinical outcomes was unexplained by prespecified hypotheses.

Conclusion: Low-dose dopamine offers transient improvements in renal physiology, but no good evidence shows that it offers important clinical benefits to patients with or at risk for acute renal failure.

Author and Article Information

From St. Michael's Hospital, Sunnybrook and Women's College Health Sciences Centre, Toronto General Hospital, University Health Network, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.

Note: Drs. Friedrich and Adhikari contributed equally to this study and are co–first authors.

Acknowledgments: The authors thank Deborah Cook and Gordon Guyatt for constructive comments on the manuscript; Stephen Walter and Michael Newman for statistical advice; Elizabeth Uleryk for assistance with bibliographic searches; and Yumiko Imai and Ayse Yuce for assistance with translation of Japanese and Turkish papers, respectively. The authors also acknowledge all authors who provided additional clinical outcomes data, in particular, Rinaldo Bellomo, Lydia de Lasson, Susan Garwood, Michael Hiesmayr and Andrea Lassnigg, Haus Leusink, Larry McNicol and Stephanie Poustie, Jerome O'Hara and Jacek Cywinski, Swen Piper, Miguel Sánchez, Karl Schulze, Pilar Taurá, Lawrence Weisberg, and Edwin Woo for also kindly providing additional renal physiologic outcomes data.

Grant Support: Dr. Beyene is supported by the Research Institute of the Hospital for Sick Children.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Jan O. Friedrich, MD, DPhil, Departments of Critical Care and Medicine, St. Michael's Hospital, 30 Bond Street, Bond Wing 4-011, Toronto, Ontario M5B 1W8, Canada; e-mail, j.friedrich{at}utoronto.ca.

Current Author Addresses: Dr. Friedrich: Departments of Critical Care and Medicine, St. Michael's Hospital, 30 Bond Street, Bond Wing 4-011, Toronto, Ontario M5B 1W8, Canada.

Dr. Adhikari: Department of Critical Care Medicine, Sunnybrook and Women's College Health Sciences Centre, 2075 Bayview Avenue, Room B7.04a, Toronto, Ontario M4N 3M5, Canada.

Dr. Herridge: Department of Respiratory and Critical Care Medicine, Toronto General Hospital, University Health Network, 585 University Avenue, NCSB 11C-1180, Toronto, Ontario M5G 2N2, Canada.

Dr. Beyene: Population Health Sciences, Research Institute, Hospital for Sick Children, Department of Public Health Sciences, University of Toronto, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada.

This article has been cited by other articles:

				J. Himmelfarb, M. Joannidis, B. Molitoris, M. Schietz, M. D. Okusa, D. Warnock, F. Laghi, S. L. Goldstein, R. Prielipp, C. R. Parikh, et al. Evaluation and Initial Management of Acute Kidney Injury Clin. J. Am. Soc. Nephrol., July 1, 2008; 3(4): 962 - 967. [Abstract] [Full Text] [PDF]

				M. Mrkobrada, H. Thiessen-Philbrook, R. B. Haynes, A. V. Iansavichus, F. Rehman, and A. X. Garg Need for Quality Improvement in Renal Systematic Reviews Clin. J. Am. Soc. Nephrol., July 1, 2008; 3(4): 1102 - 1114. [Abstract] [Full Text] [PDF]

				S. Sud MD, M. Sud BSc, J. O. Friedrich MD DPhil, and N. K.J. Adhikari MDCM MSc Effect of mechanical ventilation in the prone position on clinical outcomes in patients with acute hypoxemic respiratory failure: a systematic review and meta-analysis Can. Med. Assoc. J., April 22, 2008; 178(9): 1153 - 1161. [Abstract] [Full Text] [PDF]

				C. E. Ventetuolo and M. M. Levy Sepsis: A Clinical Update Clin. J. Am. Soc. Nephrol., March 1, 2008; 3(2): 571 - 577. [Full Text] [PDF]

				S. Herget-Rosenthal, F. Saner, and L. S. Chawla Approach to Hemodynamic Shock and Vasopressors Clin. J. Am. Soc. Nephrol., March 1, 2008; 3(2): 546 - 553. [Full Text] [PDF]

				M. H. Rosner, D. Portilla, and M. D. Okusa Analytic Reviews: Cardiac Surgery as a Cause of Acute Kidney Injury: Pathogenesis and Potential Therapies J Intensive Care Med, January 1, 2008; 23(1): 3 - 18. [Abstract] [PDF]

				R. Kunz, C. Friedrich, M. Wolbers, and J. F.E. Mann Meta-analysis: Effect of Monotherapy and Combination Therapy with Inhibitors of the Renin-Angiotensin System on Proteinuria in Renal Disease Ann Intern Med, January 1, 2008; 148(1): 30 - 48. [Abstract] [Full Text] [PDF]

				D. N. Wijeysundera, W. S. Beattie, V. Rao, J. T. Granton, and C. T. Chan N-acetylcysteine for preventing acute kidney injury in cardiac surgery patients with pre-existing moderate renal insufficiency: [Recours a la N-acetylcysteine pour prevenir une atteinte renale aigue chez les patients de chirurgie cardiaque souffrant d'une insuffisance renale moderee preexistante] Can J Anesth, November 1, 2007; 54(11): 872 - 881. [Abstract] [Full Text] [PDF]

				N. K J Adhikari, K. E A Burns, J. O Friedrich, J. T Granton, D. J Cook, and M. O Meade Effect of nitric oxide on oxygenation and mortality in acute lung injury: systematic review and meta-analysis BMJ, April 14, 2007; 334(7597): 779 - 779. [Abstract] [Full Text] [PDF]

				S. K. Jo, M. H. Rosner, and M. D. Okusa Pharmacologic Treatment of Acute Kidney Injury: Why Drugs Haven't Worked and What Is on the Horizon Clin. J. Am. Soc. Nephrol., March 1, 2007; 2(2): 356 - 365. [Abstract] [Full Text] [PDF]

				R. Venkataraman and J. A. Kellum Prevention of Acute Renal Failure Chest, January 1, 2007; 131(1): 300 - 308. [Abstract] [Full Text] [PDF]

				S. S. F. Fischer, B. Phillips-Bute, M. Swaminathan, C. Milano, and M. Stafford-Smith SymmetryTM Aortic Connector Devices and Acute Renal Injury: A Comparison of Renal Dysfunction After Three Different Aortocoronary Bypass Surgery Techniques Anesth. Analg., January 1, 2006; 102(1): 25 - 31. [Abstract] [Full Text] [PDF]

				ADDITIONAL ARTICLES ABSTRACTED IN ACP JOURNAL CLUB Evid. Based Med., October 1, 2005; 10(5): 156 - 156. [Full Text] [PDF]

				A. N. Chua and M. M. Sarwal Acute Renal Failure Management in the Neonate NeoReviews, August 1, 2005; 6(8): e369 - e376. [Full Text] [PDF]

				A. Tonks Short cuts: What's new in the other general journals BMJ, April 16, 2005; 330(7496): 867 - 868. [Full Text] [PDF]