Acute renal failure: no clear effect of low-dose dopamine on death or need for haemodialysis

Clinical bottom line (level 1a)

  1. Patients at risk of or with acute renal failure who receive low-dose dopamine compared with control are not clearly less likely to die, develop acute renal failure or require haemodialysis.
Kellum and Decker: Crit Care Med 2001; 29 : 1526-1531
Expires May 2004

The study

Systematic review of all randomised controlled trials of
  • Patients: at risk of or with acute renal failure
  • Intervention: low-dose dopamine (< 5 microg/kg/min) compared with
  • Outcome: worsening acute renal failure, need for dialysis, death

Articles found in all languages using Medline, January 1966 to December 1999 (search terms: kidney (drug effects) and dopamine ) and searching bibliographies of retrieved articles and reviews

Selection criteria: by 2 independent reviewers
Appraisal criteria: by 2 independent reviewers: randomisation
Articles excluded if: failed to meet inclusion criteria 17 RCTs found involving 854 patients

The evidence

Outcome Time to outcome CER RR
(95% CI)		 NNT
(95% CI)
death days /
(5.9%)		 0.83
(0.39 to 1.77) 		110
(NNT = 29 to infinity;
NNH = 23 to infinity)
development of acute renal failure days /
(19.5%)		 0.79
(0.54 to 1.13) 		24
(NNT = 11 to infinity;
NNH = 39 to infinity)
need for haemodialysis days /
(16.5%)		 0.89
(0.66 to 1.21) 		55
(NNT = 18 to infinity;
NNH = 29 to infinity)

Comments

  1. By limiting the search to Medline important articles may have been missed.

Citation

  1. Kellum JA, and Decker JM: use of dopamine in acute renal failure: a meta-analysis. Crit Care Med 2001; 29 : 1526-1531
Search Terms: from ACP Journal Club
Contributor: Chris Ball, May 2002
Reviewer:

Clinical Question.
Patient acute renal failure
Intervention or Exposure low-dose dopamine
Comparison placebo
Outcome death, haemodialysis, worsening acute renal failure