Acute renal failure: dopamine acutely increased urine output and creatinine clearance.

Clinical bottom line (level 2a)

  1. Dopamine acutely increased urine output and creatinine clearance in patients with oliguria or established acute renal failure.
  2. The effect on development of acute renal failure, requirement for dialysis or death was unclear.
Denton et al: Kidney International 1996; 49: 4-14
Expires August 2003

The study

Systematic review of trials of
  • Patients: acute renal failure
  • Intervention: 'renal dose' dopamine compared with no dopamine
  • Outcome: urine output, serum creatinine, creatinine clearance, glomerular filtration rate, requirement for dialysis


    • Articles found in English using MEDLINE, 1966 to 1994 (search terms: ) and hand search of Index Medicus. There was no mention of bibliographic searching, contact of authors or experts.

    Selection criteria: as above
    Appraisal criteria: no independent blinded review
    Articles excluded if: none given

    Twelve studies were identified.

    The evidence

    • Only one study was an RCT, one a prospective controlled trial, one a retrospective controlled trial and the remainder uncontrolled case series. Most employed a pre-post design.
    • Statistical summarisation of results was not attempted. Eight studies reported differences in urine output, of these six demonstrated a significant increase. Six studies reported a change in serum clearance, two demonstrated a significant decrease.
    • Five studies reported creatinine clearance or glomerular filtration rate outcomes, four demonstrated a significant increase.
    • No data on more clinically relevant end-points (development of acute renal failure, requirement for dialysis or death) was available.
    • Five of the twelve studies examined the effect of dopamine in combination with a diuretic agent (furosemide or mannitol).
    • In four studies, renal insufficiency was modest (creatinine 97 µ mol/l in three, and glomerular filtration rate 90 ml/min in one).
    • Treatment was of short duration (1-24 hours).

    Comments

    1. Considering the widespread use of dopamine in the management of oliguria in intensive care units worldwide, it is somewhat discouraging to note how few randomised studies there are.

    Citation

    1. Denton MD, Chertow GM, Brady HR: 'Renal-dose' dopamine for the treatment of acute renal failure: scientific rationale, experimental studies and clinical trials. Kidney International 1996; 49: 4-14
    Search Terms: acute renal failure [MeSH] and oliguri* [text word] OR oliguria [MeSH]
    Contributor: Catherine Clase, Chris Ball and Clare Wotton, April 2000
    Reviewer: Catherine Clase

    Clinical Question.
    Patient acute renal failure
    Intervention or Exposure dopamine
    Comparison no dopamine
    Outcome urine output, creatinine clearance