BERKELEY, CA (UroToday Inc.) - "Renal dose" intravenous dopamine (< 5 mcg/kg/min) has been thought to improve urine output by increasing renal blood flow in patients at risk for acute renal failure. Whether the drug acts by truly increasing renal blood flow or merely via a diuretic effect is a matter of debate.

In the April 5th issue of Annals of Internal Medicine, Friedrich and colleagues performed a meta-analysis to assess the efficacy of renal dose dopamine in patients at risk for acute renal failure. They evaluated sixty-one trials evaluating 3359 patients randomly assigned to dopamine or placebo.

A meta-analysis showed no effect of low-dose dopamine on mortality (relative risk, 0.96]), need for renal dialysis (relative risk, 0.93), or general complications (relative risk, 1.13). While renal dose dopamine improved urine output by 24% on the first day of use, there were no statistically significant differences in serum creatinine or measured creatinine on days 2 and 3 of therapy.

This meta-analysis failed to demonstrate that, compared to placebo, renal dose dopamine prevented renal failure or improved survival in patients at risk for renal failure. Perhaps in the future newer agents such as fenoldopam (a selective peripheral dopamine-receptor antagonist) will replace the use of dopamine in patients at risk for renal failure after surgery (Ann Thorac Surg 2004;78:1332-1337).

Ann Intern Med. 2005 Apr 5;142(7):510-24