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CORRESPONDENCE SECTION |
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| Year : 2000 | Volume
: 16
| Issue : 2 | Page : 175 |
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Renal dose dopamine in acute renal failure
V Siva Kumar
Department of Nephrology, Sri Sathya Sai Institute of Higher Medical Sciences, Prashanthigram, Anantapur District, Andhra Pradesh - 515 134, India
Correspondence Address:
V Siva Kumar
Department of Nephrology, Sri Sathya Sai Institute of Higher Medical Sciences, Prashanthigram, Anantapur District, Andhra Pradesh - 515 134
India
 Source of Support: None, Conflict of Interest: None  | Check |
Keywords: Dopamine; Acute Renal Failure.
How to cite this article:
Kumar V S. Renal dose dopamine in acute renal failure. Indian J Urol 2000;16:175 |
Compromised renal function and fall in urinary output is a common accompaniment in seriously ill patients. Because of its renal sparing potential low dose dopamine has been in wide usage in intensive care units for the prevention and treatment of acute renal failure. [1]
In healthy experimental animals or in humans, dopamine infusion was found to be having effect on dopamine receptors, beta- and alpha- adrenergic receptors at different increments of dosage. At low doses (0.5-3micrograms/kg/ minutes) dopamine was found to be causing intrarenal vasodilation and inhibition of Na-K ATPase system of proximal tubule and thick ascending limb of Henle and collecting duct, resulting in increase of renal blood flow, glomerular filtration rate and natriuresis. This response was mediated through the action of dopamine on domamine receptors (D l like and D2 like). At intermediate dose (3-10 micrograms/kg/minute) through the action on beta 1 adrenoceptors, it was found to increase cardiac index and may result in augmentation of renal perfusion. At high doses (5-20 micrograms/kg/minute) the potential benefits obtained through mediation of dopamine and beta 1 receptors were offset by systemic vasoconstriction triggered by alpha 1 adrenergic stimulation. Thus it was observed that there was significant overlap in receptor activation at various doses, there was intra and inter individual differences in the degree of effect and there was also poor correlation between dose of infusion of dopamine and its plasma levels. The response to dopamine was also variable in disease states like volume depletion, myocardial dysfunction and in the states of abnormal vasculature like atherosclerosis, hypertension, and diabetes mellitus. Hence no dose is clearly only "renal-dose dopamine" as reported in literature. [1],[2],[3],[4],[5]
Denton et al in their detailed review on the existing literature on renal-dose dopamine, found no scientifically proven utility of renal-dose dopamine either in the prevention of acute renal failure or in the treatment of established acute renal failure. As most of the studies were not controlled and their statistical power was low, they concluded that there is a need for a well-controlled randomized prospective trial to asses the efficacy of dopamine in acute renal failure. [5]
Renal-dose dopamine was found to be associated with a number of serious adverse effects like myocardial ischemia, tachyarrhythmias, myocardial infarction, depression of ventilatory drive, gut mucosal ischemia, hypokalemia and hypophosphatemia and digital gangrene. [1],[5]
To conclude, low dose dopamine did not improve survival or obviate the need for dialysis in acute renal failure. If a trial of renal-dose dopamine is initiated by its proponents, its response should be assessed within 6 hours. If there is no improvement it is prudent to discontinue the drug, to avoid its potential toxicity and cost. [6]
 References | |  |
| 1. | Thompson BT, Cockrill BA. Renal dose dopamine: a siren song? Lancet 1994; 344: 7-8.  [PUBMED] |
| 2. | Hussain T, Lokhandwala ME Renal dopamine receptor function in hypertension. Hypertension 1998; 32:187-197. |
| 3. | Lameire N, Verbeke M. Vanholder R. Prevention of clinical acute tubular necrosis with drug therapy. Nephrology Dialysis Transplantation 1995; 10:1992-2000. |
| 4. | Ravi T, Manuel P, Joseph VB. Acute renal failure. N Engl J Med 1996; 334:1448-1460. |
| 5. | Denton MD, Chertow GM, Brady HR. Renal dose dopamine for the treatment of acute renal failure. Scientific rationale, experimental studies and clinical trials. Kidney Int 1996; 50: 4-14. |
| 6. | Vijayan A, Miller SB. Acute renal failure: prevention and non dialytic therapy. Semin Nephrol 1998; 18: 523-532. [PUBMED] |
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