Use of Dopaminergic Agonists for Renal Protection in the ICU

Abstract

The mortality of acute renal failure is commonly 50–80% in the intensive care unit (ICU), and has not declined significantly since the initial marked benefit of acute dialysis therapy, despite numerous advances in renal replacement technologies and critical care over several decades. Most acute renal failure in ICU patients is caused by either prerenal azotemia (reversible renal insufficiency due to renal hypoperfusion) or acute tubular necrosis (ATN). ATN results from a variety of ischemic and nephrotoxic insults, often in additive or synergistic combination. Because renal hypoperfusion plays a role in the pathogenesis of prerenal azotemia and ATN, ‘lowdose’ dopamine dopamine is commonly used as a renal vasodilator aiming to prevent or treat acute renal failure in the ICU. This chapter reviews the use of dopamine and a novel dopaminergic agonist called fenoldopam for renal protection in the ICU.