Acute renal failure: dopamine has no clear benefit in critically-ill patients

Clinical bottom line (level 1b-)

  1. Critically-ill patients with early renal dysfunction who received a dopamine infusion compared with placebo did not have a different peak creatinine level nor a different urine output after 24 hours.
  2. Patients on dopamine were not clearly less likely to require renal replacement therapy or die.
  3. Patients on dopamine were not clearly more likely to develop arrhythmias.
ANZICS Clinical Trials Group : Lancet 2000; 356 : 2139-2143
Expires October 2004

The study

Double-blinded concealed randomised trial without intention-to-treat
Setting: 23 intensive care units, Australia and New Zealand

328 patients (aged mean 62, 60% male) with
  • early renal dysfunction (urine output averaging < 0.5 ml/kg per hour over 4 hours or longer; serum creatinine > 150 micromol/l in the absence of premorbid renal dysfunction; a rise in serum creatinine > 80 micromol/l in < 24 hours in the absence of creatine kinase > 5000 IU/l or myoglobin in the urine
  • presence of central venous catheter
  • 2 or more pathophysiological changes of the systemic inflammatory response syndrome (SIRS) over 24 hours


Excluded if
  • baseline serum creatinine > 300 micromol/l
  • enrolling physician's belief that the drug could not be administered for at least 8 hours
  • unsuitable for renal replacement therapy
  • aged < 18
  • episode of acute renal failure within previous 3 months
  • previous renal transplantation
  • use of dopamine at any dose during current hospital stay

Control Group: (n = 165, 163 analysed): placebo infusion
Experimental Group: (n = 163, 161 analysed): dopamine infusion; infused at 2 microgram/kg/min

99% followed for - days

The evidence

Outcome Time to outcome CER EER RRR
(95% CI)		 ARR
(95% CI)		 NNT
(95% CI)
creatinine > 300 micromol/l days 56
(34.4%)		 56
(34.8%)		 -1%
(-37% to 25%)		 -0.43%
(-10.8% to 9.93%)		 -230
(NNT = 10 to infinity;
NNH = 9 to infinity)
renal replacement therapy days 40
(24.5%)		 35
(21.7%)		 11%
(-32% to 40%)		 2.80%
(-6.38% to 12.0%)		 36
(NNT = 8 to infinity;
NNH = 16 to infinity)
arrhythmias days 54
(33.1%)		 53
(32.9%)		 1%
(-36% to 27%)		 0.21%
(-10.0% to 10.5%)		 480
(NNT = 10 to infinity;
NNH = 10 to infinity)
death days 66
(40.5%)		 69
(42.9%)		 -6%
(-37% to 18%)		 -2.37%
(-13.10% to 8.37%)		 -42
(NNT = 12 to infinity;
NNH = 8 to infinity)

Outcome Control Group
(SD)		 Experimental Group
(SD)		 Mean Difference
(95% CI)
peak creatinine levels 249
(147) 		245
(144) 		4
(-28 to 36)
urine output (ml/hr) after 24 hours 92
(72) 		96
(101) 		4
(-19 to 27)

Comments

  1. Patients were randomised in blocks of ten.
  2. Dopamine was infused for a mean of 113 hours.
  3. Patients were followed until discharge from hospital (roughly 30 days on average).

Citation

  1. ANZICS Clinical Trials Group , : low-dose dopamine in patients with early renal dysfunction: a placebo-controlled randomised trial. Lancet 2000; 356 : 2139-2143
Search Terms: from ACP Journal Club Other articles noted
Contributor: Chris Ball, October 2001
Reviewer: Clare Wotton

Clinical Question.
Patient critically ill with early renal dysfunction
Intervention or Exposure dopamine infusion
Comparison placebo
Outcome change in serum creatinine, need for renal replacement, death