Journal Article

Dopamine therapy for patients at risk of renal dysfunction following cardiac surgery: science or fiction?

Edwin B.C. Woo, Augustine T.M. Tang, Ahmed El Gamel, Brian Keevil, Donna Greenhalgh, Mark Patrick, Mark T. Jones and Timothy L. Hooper

in European Journal of Cardio-Thoracic Surgery

Published on behalf of European Association for Cardio-Thoracic Surgery

Volume 22, issue 1, pages 106-111
Published in print July 2002 | ISSN: 1010-7940
Published online July 2002 | e-ISSN: 1873-734X | DOI: https://dx.doi.org/10.1016/S1010-7940(02)00246-4
Dopamine therapy for patients at risk of renal dysfunction following cardiac surgery: science or fiction?

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  • Cardiothoracic Anaesthesia
  • Clinical Pharmacology and Therapeutics
  • Cardiovascular Medicine
  • Cardiothoracic Surgery

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Objectives: We aimed to evaluate the renoprotective role of renal-dose dopamine on cardiac surgical patients at high risk of postoperative renal dysfunction. The latter included older patients or those with pre-existing renal disease, elevated preoperative serum creatinine (Cr), poor ventricular function, hypertension, diabetes mellitus and unstable angina requiring intravenous therapy. Methods: Fifty patients undergoing cardiopulmonary bypass (CPB) who fulfilled the entry criteria were prospectively randomized into two groups: Group 1 received a ‘renal-dose’ (3 μg kg−1 min−1) dopamine infusion starting at anaesthetic induction for 48 h whilst saline infusion acted as placebo in Group 2. The anaesthetic and CPB regimes were standardized. Urinary excretion of retinol binding protein (RBP) indexed to Cr, an accurate and sensitive marker of early renal tubular damage, was assessed daily for 6 days. Additional outcome measures included daily fluid balance, blood urea and serum Cr. Statistical comparisons were made using ANOVA and Mann–Whitney U-test. Results: No significant difference was found between the groups in their age, gender, preoperative NYHA class, ejection fraction, baseline serum Cr and duration of CPB and aortic cross-clamping. Renal replacement therapy was not required in any instance. Both groups demonstrated a similar and significant rise in urinary RBP throughout the study period. Dopamine-treated patients achieved more negative average fluid balance than those on placebo (5 vs. 229 ml, P≪0.05). Conclusions: Renal-dose dopamine therapy failed to offer additional renoprotection to patients considered at increased risk of renal dysfunction after CPB.

Keywords: Anaesthesia; Blood flow; Cardiopulmonary bypass; Kidney; Vasodilation

Journal Article.  3283 words.  Illustrated.

Subjects: Cardiothoracic Anaesthesia ; Clinical Pharmacology and Therapeutics ; Cardiovascular Medicine ; Cardiothoracic Surgery

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