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The renal effect of low-dose dopamine in high-risk patients undergoing coronary angiography
M Gare1, Y S Haviv, A Ben-Yehuda
1Cardiology Department, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
Insights
Low-dose dopamine did not protect high-risk patients from contrast nephropathy during coronary angiography. However, dopamine should be avoided in patients with peripheral vascular disease due to potential harm.
Area of Science:
- Nephrology
- Cardiology
- Pharmacology
Background:
- Contrast nephropathy is a common complication in patients with chronic renal failure (CRF) and/or diabetes mellitus (DM).
- Renal blood flow reduction due to vasoconstriction is a suspected mechanism.
- Low-dose dopamine may dilate renal vasculature.
Purpose of the Study:
- To investigate the potential renal protective effects of low-dose dopamine in patients undergoing coronary angiography.
- To assess dopamine's efficacy in preventing contrast-induced nephropathy in high-risk individuals.
Main Methods:
- A prospective, double-blind, randomized study involving 66 patients with mild to moderate CRF and/or DM.
- Patients received either saline with dopamine (2 microg/kg/min) or saline alone for 48 hours.
- Plasma creatinine levels were monitored before and after coronary angiography.
Main Results:
- Both groups showed a significant increase in plasma creatinine levels post-angiography.
- No significant difference in creatinine change (deltaCr) was observed between the dopamine and control groups overall.
- A significant increase in deltaCr was noted in the dopamine group compared to the control group specifically in patients with peripheral vascular disease (PVD).
Conclusions:
- Contrast media administration leads to a minor but significant increase in creatinine levels in high-risk patients.
- Dopamine offers no additional benefit over adequate hydration for preventing contrast nephropathy in patients with mild/moderate renal failure or diabetes.
- Dopamine administration should be contraindicated in patients with PVD undergoing procedures involving contrast media.
Objectives:
The purpose of the study was to examine the potential renal protective effect of low-dose dopamine in high-risk patients undergoing coronary angiography.
Background:
Contrast nephropathy is prevalent in patients with chronic renal failure (CRF) and/or diabetes mellitus (DM). Decreased renal blood flow due to vasoconstriction was suggested as a contributory mechanism. Low-dose dopamine has a dilatory effect on the renal vasculature.
Methods:
Sixty-six patients with mild or moderate CRF and/or DM undergoing coronary angiography were prospectively double-blindedly randomized, to either 120 ml/day of 0.9% saline plus dopamine 2 microg/kg/min (Dopamine group) or saline alone (Control group) for 48 h.
Results:
Thirty-three Dopamine-treated (30 diabetics and 6 with CRF) and 33 Control (28 diabetics and 5 with CRF) patients were compared. Plasma creatinine (Cr) level increased in the Control group from 100.6+/-5.2 before to 112.3+/-8.0 micromol/liter within five days after angiography (p = 0.003), and in the Dopamine group from 100.3+/-5.4 before to 117.5+/-8.8 micromol/liter after angiography (p = 0.0001), respectively. There was no significant difference in the change of Cr level (deltaCr) between the two groups. However, in a subgroup of patients with peripheral vascular disease (PVD), deltaCr was -2.4+/-2.3 in the Control group and 30.0+/-12.0 micromol/liter in the Dopamine group (p = 0.01). No significant difference occurred in deltaCr between Control and Dopamine in subgroups of patients with preangiographic CRF or DM.
Conclusions:
Contrast material caused a small but significant increase in Cr blood level in high-risk patients. There is no advantage of dopamine over adequate hydration in patients with mild to moderate renal failure or DM undergoing coronary angiography. Dopamine should be avoided in patients with PVD exposed to contrast medium.