Meta-analysis: low-dose dopamine increases urine output but does not prevent renal dysfunction or death

Abstract

Background: Surveys have documented the continued popularity of low-dose dopamine to influence renal dysfunction even though few data support it and editorials and reviews have discouraged its use.

Purpose: To evaluate the effects of low-dose dopamine (< or =5 microg/kg of body weight per minute) compared with placebo or no therapy in patients with or at risk for acute renal failure.

Data sources: MEDLINE (1966-January 2005), EMBASE (1980-week 5, 2005), CANCERLIT (1975-2002), CINAHL (1982-January 2005), and CENTRAL (The Cochrane Library, fourth quarter, 2004); bibliographies of retrieved publications; and additional information from 50 trials.

Study selection: Two reviewers independently selected parallel-group randomized and quasi-randomized controlled trials of low-dose dopamine versus control.

Data extraction: Study methods, clinical and renal physiologic outcomes, and adverse events (arrhythmias and myocardial, limb, and cutaneous ischemia) were extracted.

Data synthesis: 61 trials that randomly assigned 3359 patients were identified. Meta-analyses using random-effects models showed no effect of low-dose dopamine on mortality (relative risk, 0.96 [95% CI, 0.78 to 1.19]), need for renal replacement therapy (relative risk, 0.93 [CI, 0.76 to 1.15]), or adverse events (relative risk, 1.13 [CI, 0.90 to 1.41]). Low-dose dopamine increased urine output by 24% (CI, 14% to 35%) on day 1. Improvements in serum creatinine level (4% relative decrease [CI, 1% to 7%]) and measured creatinine clearance (6% relative increase [CI, 1% to 11%]) on day 1 were clinically insignificant. There were no significant changes on days 2 and 3 of therapy.

Limitations: Statistically significant between-study heterogeneity in physiologic but not clinical outcomes was unexplained by prespecified hypotheses.

Conclusion: Low-dose dopamine offers transient improvements in renal physiology, but no good evidence shows that it offers important clinical benefits to patients with or at risk for acute renal failure.