Abstract
According to the guidelines for cardiogenic shock, norepinephrine is associated with fewer arrhythmias than dopamine and may be the better first-line vasopressor agent. This study aimed to evaluate the utility of norepinephrine vs. dopamine as first-line vasopressor agent for cardiovascular shock depending on the presence and severity of renal dysfunction at hospitalization. This was a secondary analysis of the prospective, multicenter Japanese Circulation Society Cardiovascular Shock Registry (JCS Shock Registry) conducted between 2012 and 2014, which included patients with shock complicating emergency cardiovascular disease at hospital arrival. The analysis included 240 adult patients treated with norepinephrine alone (n = 98) or dopamine alone (n = 142) as the first-line vasopressor agent. Primary endpoint was mortality at 30 days after hospital arrival. The two groups had similar baseline characteristics, including estimated glomerular filtration rate (eGFR), and similar 30-day mortality rates. The analysis of the relationship between 30-day mortality rate after hospital arrival and vasopressor agent used in patients categorized according to the eGFR-based chronic kidney disease classification revealed that norepinephrine as the first-line vasopressor agent might be associated with better prognosis of cardiovascular shock in patients with mildly compromised renal function at admission (0.0 vs. 22.6%; P = 0.010) and that dopamine as the first-line vasopressor agent might be beneficial for cardiovascular shock in patients with severely compromised renal function [odds ratio; 0.22 (95% confidence interval 0.05–0.88; P = 0.032)]. Choice of first-line vasopressor agent should be based on renal function at hospital arrival for patients in cardiovascular shock.Clinical Trial Registration: http://www.umin.ac.jp/ctr/, Unique identifier: 000008441.
Highlights
The number of patients with chronic kidney disease (CKD) has been markedly increasing worldwide [1]
In the present study based on the largest nationwide registry of patients with cardiovascular shock caused by various causes of cardiovascular disease (CVD), we assessed the actual use and utility of vasopressor agents for cardiovascular shock within 24 h of arrival at emergency department (ED) in patients with poor renal function
We showed the firstline vasopressor agent, such as norepinephrine and dopamine, should be chosen based on renal function at hospital arrival for patients in cardiovascular shock
Summary
The number of patients with chronic kidney disease (CKD) has been markedly increasing worldwide [1]. CKD is an important risk factor for cardiovascular events and accounts for all-cause mortality in patients with cardiovascular disease (CVD) [2– 5]. Cardiogenic shock is a serious cardiovascular event associated with a high mortality rate [6–8]. In patients with cardiogenic shock, vasopressor agents are indicated in patients with severe or persistent hypotension despite fluid administration, and various vasopressor agents have been used for the treatment of cardiogenic shock. According to the clinical statements and guidelines for the management of cardiogenic shock, norepinephrine is associated with fewer arrhythmias and is the vasopressor agent of choice in many patients with cardiogenic shock; the optimal first-line vasopressor agent for cardiogenic shock patients remains unclear [9, 10]. No clinical studies to date have investigated the effects of first-line vasopressor agents for cardiogenic shock in patients with poor renal function
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