Preventing renal failure in the critically ill

Few doctors trained in the past 20 years have not learnt of the benefits of “low dose” dopamine in patients developing acute renal failure. The belief that low dose dopamine is beneficial was based on the physiological and pharmacological properties of dopamine and on personal anecdotes, but there is a lack of clinical trials, those available being of poor quality.1 The recent publication of a high quality randomised, double blind, placebo controlled study2 showing no benefit of “low dose” dopamine has, therefore, killed—or at least mortally wounded given that it takes time for cardiac surgeons to catch up—one of critical care's sacred cows. In this study 328 patients (in 23 Australasian intensive care units) with an acute inflammatory response and early renal dysfunction (raised serum creatinine concentration or oliguria) randomly received a dopamine infusion (2 μg/kg/min) or placebo. The primary outcome variable, peak serum creatinine concentration during infusion, did not differ between the well matched groups. Moreover, there was no difference in any other variable studied, including requirement for dialysis. Indeed, urine output and use of frusemide did not differ, suggesting that dopamine was not even an effective diuretic. A possible criticism of the …