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Renal effects of low-dose dopamine in patients with sepsis syndrome or septic shock treated with catecholamines
T Lherm1, G Troché, M Rossignol
1Departement d'Anesthésie-Réanimation, Hôpital Antoine Béclère, Université Paris-Sud, Clamart, France.
Objective:
To evaluate the renal effects of low-dose dopamine in patients with sepsis syndrome or septic shock treated with catecholamines.
Design:
Prospective, clinical study using sequential periods.
Setting:
A 12-bed surgical intensive care unit in a university hospital.
Patients:
14 patients with sepsis syndrome and 15 patients with septic shock treated with exogenous catecholamines were studied. They had no diuretic treatment.
Intervention:
Two periods of 2 h each with and without 2 micrograms.kg-1.min-1 of dopamine infusion. Hemodynamic and renal data were obtained at the end of each period. Measurements were repeated after 48 h of dopamine infusion in patients with sepsis syndrome. All data were evaluated by the Wilcoxon rank test.
Measurements And Results:
In patients with sepsis syndrome, diuresis and creatinine clearance increased significantly by 100% and 60%, respectively, during low-dose dopamine infusion without any change in systemic hemodynamics. The renal response to dopamine decreased significantly after 48 h of dopamine infusion (P < 0.01). In patients with septic shock treated with catecholamines, no variation of either systemic hemodynamics or renal function was noted during low-dose dopamine infusion.
Conclusion:
The renal effects of low-dose dopamine in patients with sepsis syndrome decrease with time. No renal effect of low-dose dopamine was observed in patients with septic shock treated with catecholamines. These findings suggest a desensitization of renal dopaminergic receptors.