The benefit of low‐dose dopamine during vigorous diuresis for congestive heart failure associated with renal insufficiency: Does it protect renal function?

Abstract Background : Low‐dose dopamine, a renal vasodilator, has been used empirically to improve renal function or outcome in critically ill patients with oliguria or acute renal failure. Hypothesis : This study was designed to investigate the efficacy of low‐dose dopamine (2 μg/kg/min) as a renal‐protective agent during vigorous diuresis for congestive heart failure (CHF) associated with mild or moderate renal insufficiency. Methods : Of 20 study patients (mean age 74.3 ± 15 years) with severe CHF, 10 (Group A) were randomized to a treatment strategy of intravenous bumetanide (1 mg b.i.d.) alone and another 10 (Group B) to low‐dose dopamine and a similar diuretic regimen for a duration of 5 days or less if clinical edema remitted. Results : Group B patients showed a significant improvement in renal function and urinary output: serum blood urea nitrogen 48.9 ± 10.3 to 32.1 ± 14.4 mg/dl (p<0.05); serum creatinine 1.97 ± 0.24 to 1.49 ± 0.39 mg/dl (p“0.05); creatinine clearance 35.6 ± 11.6 to 48.8 ± 12.3 ml/min (p“0.05); and indexed urinary output 0.56±0.16 to 2.02±0.72 ml/kg/h (p“0.05). Group A patients showed a significant increase in urinary output but nonsignificant renal functional deterioration. Conclusion : The renal‐protective effect of low‐dose dopamine in the setting of CHF and vigorous diuresis is supported by this study.