Meta-analysis: low-dose dopamine increases urine output but does not prevent renal dysfunction or death

Area of Science:

• Nephrology
• Critical Care Medicine
• Pharmacology

Background:

• Despite limited supporting data and expert discouragement, low-dose dopamine remains popular for managing renal dysfunction.
• This study addresses the continued use of low-dose dopamine in patients with or at risk for acute renal failure.

Purpose of the Study:

• To evaluate the clinical efficacy of low-dose dopamine (<=5 microg/kg/min) compared to placebo or no therapy in patients with or at risk for acute renal failure.

Main Methods:

• A systematic review and meta-analysis of parallel-group randomized and quasi-randomized controlled trials.
• Searched MEDLINE, EMBASE, CANCERLIT, CINAHL, and CENTRAL databases (up to 2005).
• Extracted data on study methods, clinical and renal physiologic outcomes, and adverse events.

Main Results:

• 61 trials involving 3359 patients were analyzed.
• Low-dose dopamine showed no significant effect on mortality, need for renal replacement therapy, or adverse events.
• Transient increases in urine output (24%) and minor, clinically insignificant improvements in serum creatinine and creatinine clearance were observed on day 1, with no significant changes on subsequent days.

Conclusions:

• Low-dose dopamine provides temporary improvements in renal physiology but lacks evidence of significant clinical benefit for patients with or at risk for acute renal failure.
• Unexplained heterogeneity in physiologic outcomes suggests further research is needed.