135: Efficacy of Low-Dose Dopamine Plus Loop Diuretics in Acute Decompensated Heart Failure

Introduction: Acute decompensated heart failure (ADHF) is a challenging condition, particularly in patients with concomitant renal dysfunction. Although loop diuretics are the cornerstone of decongestive therapy, there can be limitations to their use. Low-dose dopamine (< 3 mcg/kg/min) has been suggested as a renal-adjunctive therapy due to its potential vasodilatory effects on renal perfusion; however, existing literature is conflicting regarding the efficacy and safety of using low-dose dopamine in ADHF. The purpose of this study is to assess the efficacy and safety of low-dose dopamine in conjunction with loop diuretics. Methods: This was a single-center retrospective study of adult patients with ADHF who were admitted from January 2020 to April 2025 and received loop diuretics with or without low-dose dopamine. Patients on chronic hemodialysis, mechanical circulatory support, or incomplete documentation for urine output, weight, or renal function were excluded. The primary objective was cumulative urine output over 24 hours. Secondary objectives were change in weight and serum creatinine at 72 hours, incidence of tachyarrhythmias, and ICU length of stay. Variables and outcomes were analyzed with appropriate statistical tests. Results: In the unmatched analysis, 55 patients were included in the dopamine group, and 227 patients were in the control group. The dopamine group had a greater median urine output over 24 hours compared to the control group (4300 IQR 2875-5710 vs 3100 mL IQR 2050-4670, p< 0.05), in addition to an increased incidence of tachyarrhythmias (25% vs 11%, p< 0.05). Length of stay in the ICU was longer in the dopamine group (10 IQR 6-28 vs 4 days IQR 2-7, p< 0.05). There was also a greater decrease in weight (-3 IQR -7.21 to -0.4 vs -2.3 kg IQR -4.6 to 0.6, p< 0.05) and serum creatinine at 72 hours (-0.24 IQR -0.51 to -0.05 vs -0.01 mg/dL IQR -0.22 to 0.17, p< 0.05) in the dopamine group. Conclusions: There was a statistically significant greater cumulative urine output over 24 hours in the dopamine group. These results suggest low-dose dopamine in combination with loop diuretics may have decongestive effects in patients with ADHF but with an increased risk of tachyarrhythmias.