Low-dose Dopamine Research Articles

Effect of intravenous dopamine infusion on pituitary and thyroid function and on nephroprotection

INTRODUCTION; Catecholamines, including dopamine, are used in cardiac intensive care. The aim of the study was to assess the effect of intravenous dopamine infusion on the function of pituitary gland in patients with acute cardiac failure. We analyzed changes in the serum levels of thyroid-stimulating hormone (TSH) and adrenocorticotropic hormone (ACTH), as well as potential nephroprotection. The study involved 29 patients with chronic decompensated heart failure (New York Heart Association class III/IV; mean age 77.4 ± 13.3 years). Dopamine was administered intravenously in doses varying from 1 to 5 μg/kg/min. Measurements of TSH, free triiodothyronine (FT3), free thyroxine (FT4), and ACTH were taken directly before dopamine infusion, after 12 hours of continuous infusion, and 12 hours after the 72-hour infusion was completed. Serum FT3 levels were significantly higher before dopamine infusion than at 12 hours post infusion (5.12 ± 1.16 vs. 4.27 ± 0.89 pmol/l, P < 0.005). Serum FT4 levels before the infusion were significantly higher than after 12 hours of continuous infusion as well as after 12 hours post infusion (18.79 ± 5.33 vs. 17.06 ± 4.61 pmol/l, P < 0.05; 18.79 ± 5.33 vs. 16.26 ± 4.53 pmol/l, P < 0.05, respectively). There were no statistically significant differences between serum TSH and ACTH levels or in creatinine clearance before, during, and 12 hours post infusion. Intravenous infusion of dopamine may downregulate endocrine thyroid function; however, it has no significant effect on the pituitary gland-derived TSH and ACTH. There was no significant nephroprotective effect of low-dose dopamine infusion in patients with chronic decompensated chronic heart failure.

Effect of low dose dopamine on early graft function in living unrelated kidney donors.

To evaluate the effect of low-dose dopamine administration on the early function of the kidney in unrelated kidney donors after transplantation. In this double-blinded clinical trial, 60 adult kidney donors and 60 recipients, younger than 50 years old, were studied. Donors and recipients were randomly divided into two groups; group 1 received dopamine 3 µ/kg/min and group 2 received similar regimen of placebo. During the first 3 days postoperatively, serum levels of urea and creatinine as well as urine output and early kidney function were compared between two groups. Serum levels of creatinine and urea and urine output during the first three days after the operation did not differ statistically significantly between two groups (P = .549, P = .306, and P = .375, respectively). Early kidney function was better significantly in group 1 (5.3 ± 3.2 versus 8.6 ± 8.0 hours; P = .048). Premedication of the kidney transplant donors with low-dose dopamine accelerates early kidney function after transplantation, but has no effect on the hemodynamic status and serum levels of creatinine and urea in the donors.

Donor Desmopressin Is Associated With Superior Graft Survival After Kidney Transplantation

A recent randomized trial showed that pretreatment of the brain-dead donor with low-dose dopamine improves immediate kidney graft function, by limiting injury from cold storage (ClinicalTrials.gov Identifier: NCT00115115). This study determines whether donor exposure to desmopressin (1-deamino-8-d-arginine-vasopressin [DDAVP]) before organ retrieval affects renal transplant outcome. This retrospective multicenter cohort study, nested in the database of the dopamine trial, includes 264 deceased heart-beating donors with confirmed brain death and corresponding 487 renal allograft recipients transplanted at 60 European centers between March 2004 and August 2007. We assessed differences in delayed graft function, biopsy-proven acute rejections, and 2-year kidney graft survival in recipients of a DDAVP-exposed versus unexposed graft. DDAVP was associated with improved graft survival (85.4% vs. 73.6%, P=0.003). This survival benefit persisted after censoring for death with functioning graft (91.1% vs. 82.0%, P=0.01) and after adjustment for confounders including covariate adjustment from propensity scoring (hazard ratio 0.40, 95% confidence interval [CI] 0.21-0.77; P=0.006). Delayed graft function (odds ratio 0.97, 95% CI 0.57-1.65; P=0.92) and biopsy-proven acute rejections (odds ratio 1.32, 95% CI 0.70-2.49; P=0.40) were unaffected. The survival effect was enhanced after a shorter cold ischemic time less than 14 hr (91.3% vs. 77.8%, P=0.008) and after dopamine pretreatment (92.7% vs. 78.6%, P=0.006). By contrast, prolonged cold ischemic time more than or equal to 14 hr (91.2% vs. 86.5%, P=0.39) and assignment to the nondopamine group (89.7% vs. 84.8%, P=0.37) abrogated the survival advantage. Donor DDAVP seems to improve renal allograft survival. Combined use of donor DDAVP and low-dose dopamine should receive further evaluation.

Antipsychotic-Induced Hyperprolactinaemia

Antipsychotic medications are a potential cause of hyperprolactinaemia and may be implicated in the development of pituitary adenomas. This review examines the effect of different antipsychotic medications on prolactin and sexual function, and provides practical guidelines for investigation and management of antipsychotic-induced hyperprolactinaemia. Literature review. Antipsychotic-induced hyperprolactinaemia occurs overall in up to 70% of patients with schizophrenia, depending on the medications used. It is associated with significant levels of hypogonadism and sexual dysfunction, which in general relates to the degree of prolactin elevation. A consequence of the hypogonadism is clinically significant bone loss which may lead to osteoporosis and increased risk of minimal trauma fracture. Where the potentially offending drug cannot be safely withdrawn to document a normal prolactin, imaging with MRI should be undertaken to exclude a structural pituitary lesion. The management strategy of choice is switching to a prolactin-sparing antipsychotic. Sex steroid replacement can reverse many of the adverse effects including the hypogonadal symptoms and bone loss. Low dose dopamine agonist therapy should be used with caution as a third line treatment, since there have been cases of dopamine agonist-induced exacerbation of psychosis. There is a need for a randomised controlled trial of low dose dopamine agonist therapy versus sex steroid replacement to establish the relative safety and efficacy of each approach.

Effects of Donor Pre-Treatment With Dopamine on Survival After Heart Transplantation: A Cohort Study of Heart Transplant Recipients Nested in a Randomized Controlled Multicenter Trial

We determined the outcome of cardiac allografts from multiorgan donors enrolled in a randomized trial of donor pre-treatment with dopamine. Treatment of the brain-dead donor with low-dose dopamine improves immediate graft function after kidney transplantation. A cohort study of 93 heart transplants from 21 European centers was undertaken between March 2004 and August 2007. We assessed post-transplant left ventricular function (LVF), requirement of a left ventricular assist device (LVAD) or biventricular assist device (BVAD), need for hemofiltration, acute rejection, and survival of recipients of a dopamine-treated versus untreated graft. Donor dopamine was associated with improved survival 3 years after transplantation (87.0% vs. 67.8%, p = 0.03). Fewer recipients of a pre-treated graft required hemofiltration after transplant (21.7% vs. 40.4%, p = 0.05). Impaired LVF (15.2% vs. 21.3%, p = 0.59), requirement of a LVAD (4.4% vs. 10.6%, p = 0.44), and biopsy-proven acute rejection (19.6% vs. 14.9%, p = 0.59) were not statistically different between groups. Post-transplant impaired LVF (hazard ratio [HR]: 4.95; 95% confidence interval [CI]: 2.08 to 11.79; p < 0.001), requirement of LVAD (HR: 6.65; 95% CI: 2.40 to 18.45; p < 0.001), and hemofiltration (HR: 2.83; 95% CI: 1.20 to 6.69; p = 0.02) were predictive of death. The survival benefit remained (HR: 0.33; 95% CI: 0.12 to 0.89; p = 0.03) after adjustment for various risks affecting mortality, including pre-transplant LVAD/BVAD, inotropic support, and impaired kidney function. Treatment of brain-dead donors with dopamine of 4 μg/kg/min will not harm cardiac allografts but appears to improve the clinical course of the heart allograft recipient. (Prospective Randomized Trial to Evaluate the Efficacy of Donor Preconditioning With Dopamine on Initial Graft Function After Kidney Transplantation; NCT00115115).

Evolving Treatment Strategies for Management of Cardiorenal Syndrome

The treatment of acute decompensated heart failure in the presence of progressive renal dysfunction is a commonly encountered dilemma in clinical practice. Also known as cardiorenal syndrome, this complex disease state has forced researchers and clinicians to develop new treatment strategies to relieve the symptomatic congestion of heart failure while preserving renal function. Loop diuretics remain the standard of pharmacologic treatment of acute heart failure, but their effects on renal function have been called into question. The DOSE trial set out to determine optimal diuretic dosing strategies but no clear regimen was firmly established. Initial studies with vasopressin antagonists showed promise in their ability to increase urine output, provide short-term symptom relief, and correct hyponatremia while maintaining renal function. Unfortunately, the EVEREST trial did not demonstrate any benefit on long-term clinical outcomes. Adenosine antagonists also appeared to be an emerging therapeutic option, but the recently completed PROTECT trial failed to establish their role in the treatment of cardiorenal syndrome. Both nesiritide and low-dose dopamine have endured years of trials with mixed results. Most recently, findings from the ASCEND-HF trial showed that nesiritide was safe with no adverse effects on renal function or mortality and was associated with a modest improvement in dyspnea. The ongoing ROSE study, sponsored by the National Institutes of Health Heart Failure Research Network, will attempt to confirm the safety and efficacy profiles of low-dose nesiritide and dopamine, as well as clarify their roles within acute heart failure management. Despite its inherent complexities, ultrafiltration has demonstrated potential benefit in several clinical outcomes compared to traditional pharmacotherapy. The results of the CARRESS-HF trial will reveal how the use of ultrafiltration specifically applies to patients with cardiorenal syndrome. The most exciting aspects about our evolving understanding of the cardiorenal system are the innovative treatments that have emerged as a result. The creation of chimeric natriuretic peptides, targeted intra-renal pharmacotherapy, the novel use of phosphodiesterase inhibitors, and combination treatment strategies demonstrate that despite our varied success in treating cardiorenal syndrome in the past, there are highly encouraging translational therapies rapidly developing in the pipeline.

Cardiac Surgery Without Blood Products in a Jehovah's Witness Child With Factor VII Deficiency

In the case reported here, the situation was complicated by a congenital deficiency of factor VII (FVII), which increased the risk of surgical and postoperative bleeding. Perioperative rotational thromboelastometry coagulation monitoring avoided empiric prophylactic treatment with recombinant activated FVII (rFVIIa). CASE REPORT A 5-year-old girl weighing 37.8 lb of the JW faith without cardiologic symptoms or a history of bleeding episodes had been diagnosed with ostium secundum atrial septal defect (ASD) by echocardiogram and was scheduled for transcatheter device closure of the defect. The transesophageal echocardiographic study and cardiac catheterization confirmed a 16-mm diameter defect (Qp:Qs ratio of 2.4:1) and contraindicated transcatheter device closure due to insufficient rims and the extension of the defect into the inferior vena cava. The patient was scheduled for ASD closure with CPB. The patient’s parents, also JWs, did not authorize the use of whole blood or blood components (ie, packed red blood cells, fresh frozen plasma, platelets, and cryoprecipitate), but accepted the use of coagulation factor concentrates (ie, fibrinogen, factor VIIa, and prothrombin complex), erythropoietin, intravenous iron, and cell salvage. Preoperative routine tests showed a hemoglobin (Hb) concentration of 12.5 g/dL, hematocrit of 36.6%, a mild iron deficit (iron: 45 g/dL, transferrin: 253 mg/dL, transferrin saturation: 14%, ferritin: 40 ng/mL, and total iron-binding capacity: 321 g/dL), and an abnormal prothrombin time (PT) of 15 seconds (63% activity, international normalized ratio 1.3) with a normal activated partial thromboplastin time. After the confirmation of prolonged PT, further investigations revealed a mild FVII deficiency (43.3% activity), whereas all other coagulation factors were within the normal range. Surgery was scheduled 13 days later to allow adequate preparation of the patient and to avoid the administration of blood products during the procedure. Treatment was initiated with a short preoperative course of 7 doses of subcutaneous human recombinant erythropoietin (r-HuEPO) at a dosage of 600 U/kg every other day. At the start of erythropoietin treatment, the maximum single intravenous dose of ferric carboxymaltose (255 mg) was administered in a 15-minute infusion to prevent relative iron deficiency. The patient also received oral supplements of vitamin B12 and folic acid throughout the preoperative period. A complete blood count and coagulation panel were obtained the day before surgery, showing an increase in Hb of 2 g/dL. The PT remained prolonged because of the FVII deficiency. Laboratory findings from preoperative and postoperative tests are summarized in Table 1. Anesthesia management consisted of induction with sevoflurane in oxygen and air, followed by fentanyl and cisatracurium administration to facilitate endotracheal intubation, and maintenance with remifentanil, 0.25 g/kg/min, and 2% sevoflurane in an oxygen/air mixture. A radial arterial catheter and a right internal jugular central venous catheter were inserted for invasive pressure monitoring. Near-infrared spectroscopy and bispectral index were used for neurologic monitoring. After heparin administration and cannulation, a direct suturing of the edges of the ASD was performed under moderate hypothermic (32°C) CPB (36 minutes) with a cross-clamp time of 18 minutes. After rewarming, modified ultrafiltration, and protamine administration, weaning from CPB was achieved uneventfully using a continuous infusion of low-dose dopamine (3 g/kg/min). Preoperative erythropoietin treatment was combined with fibrinolytic prophylaxis intraoperatively (tranexamic acid given in a bolus dose of 15 mg/kg before surgical incision), a meticulous surgical technique, a crystalloid low-volume priming CPB circuit (500 mL), modified ultrafiltration (500 mL), and a reduction in the number and volume of blood samples for laboratory tests. During and immediately after surgery, coagulation was monitored with rotational thromboelastometry (ROTEM; TEM International, GmbH, Munich, Germany), which made the administration of coagulation factor concentrates unnecessary (Table 2). Bleeding was not heavier than normal. The chest drains were removed 48 hours after surgery with a total volume of 106 mL. The patient was discharged from the pediatric intensive care unit on day 2 after the surgery and was sent home on day 6. No transfusions of blood products were administered.

Is Circadian Rhythm Disruption Important in Obsessive-Compulsive Disorder (OCD)? A Case of Successful Augmentation With Agomelatine for the Treatment of OCD

The main augmentation strategy in the treatment of obsessive-compulsive disorder (OCD) is the addition of low-dose dopamine antagonists, such as risperidone. However, the development of additional pharmacological therapeutics is necessary because some patients remain refractory to these strategies. In the present report, we describe an adult male patient with clomipramine treatment-resistant OCD who did not respond to augmentation with risperidone and aripiprazole but who showed clinical improvement with agomelatine. The effect of agomelatine in resynchronizing circadian rhythms may demonstrate the importance of the circadian rhythm disruption observed in OCD. Moreover, the regulation of the serotoninergic system is circadian in nature, and the resynchronization of the serotoninergic system may regulate serotoninergic dysfunction, a major factor in OCD.

Cardiac valve disease and low-dose dopamine agonist therapy: an artefact of reporting bias?

Chronic low-dose cabergoline treatment for microprolactinoma may cause cardiac valve pathology, but the evidence is contradictory. We investigated whether the expectation of the echocardiographer could influence the report. Transthoracic echocardiograms from 40 patients aged 49·3 ± 9·6 (mean ± SD) years (Men:Women 7:33) on long-term cabergoline and bromocriptine therapy (duration 9·94 ± 4·5 years) were randomly assigned to two groups of echocardiographers so that each echocardiogram was reported twice. One group was told that 'the patients were control subjects' (Group A) and the other that 'the patients were on dopamine agonist therapy which is known to cause valve disease' (Group B). An observer who was blind to the group scored the reports for regurgitation at each valve (scores 0-4; max 16 per case). Mean total regurgitation score was significantly higher in Group B (1·43 ± 1·28; P = 0·014) than in Group A (0·73 ± 1·30). The difference was mainly from reporting trivial regurgitation: (mitral 16 vs 5, P = 0·005; tricuspid 17 vs 6, P = 0·007 and pulmonary 8 vs 1, P = 0·013). Mild regurgitation was uncommon (mitral 1 vs 1 and tricuspid 3 vs 6). Moderate regurgitation occurred in only one case and was associated with restriction of the leaflets consistent with the effects of cabergoline. Valve thickening was not reported in Group A, but in 9 (23%) mitral and 4 (10%) aortic valves in Group B. Long-term, low-dose dopamine agonist therapy rarely causes cardiac valve disease, but operator bias can lead to over-reporting of both valve thickening and trivial regurgitation.

A Randomized Controlled Trial of Terlipressin and Albumin Versus Albumin, Low Dose Dopamine and Frusemide in Hepatorenal Syndrome

A Randomized Controlled Trial of Terlipressin and Albumin Versus Albumin, Low Dose Dopamine and Frusemide in Hepatorenal Syndrome

L’insuffisance rénale aiguë : du concept à la pratique

Definition and classification of acute renal failure evolved in recent years. The acronym “Acute Kidney Injury” replaces “Acute Renal Failure”. The RIFLE classification spreads the AKI in three degrees of severity, and two degrees of disease duration. The group Acute Kidney Injury Network refines this classification into three stages, to improve the sensitivity in detecting moderate forms. The epidemiology of AKI remains imprecise. In the ICU, more than 30% of patients suffered from AKI, often in a context of multiple organs failure. In addition to serum creatinine and urine output, new biomarkers can be assessed. Their early detection should enable a clearer distinction between “acute tubular necrosis” and other causes of AKI, but also to distinguish patients at risk for pejorative evolution of renal function. The management of AKI based on an optimal resuscitation. The administration of loop diuretics or low dose dopamine showed no benefit. Hydration in prevention of the contrast-induced nephropathy is confirmed. The role of acetylcysteine must be determined. The ideal time to initiate a renal replacement therapy and the choice of the technique remain unresolved. The same goes for the dose of dialysis administered. A systematic application of an algorithm, such as proposed by Bagshow would make comparisons easier and the realisation of multicenter studies will help to clarify these points.

Impact of Dopamine Infusion on Renal Function in Hospitalized Heart Failure Patients: Results of the Dopamine in Acute Decompensated Heart Failure (DAD-HF) Trial

Background Worsening renal function (WRF) and hypokalemia related to diuretic use for acute decompensated heart failure (ADHF) are common and associated with poor prognosis. Low-dose dopamine infusion improves renal perfusion; its effect on diuresis or renal function specifically in ADHF is not known. Methods and Results Sixty consecutive ADHF patients (age 75.7 ± 11.2 years; 51.7% female; left ventricular ejection fraction 35.3 ± 12.1%) were randomized, after receiving a 40 mg intravenous furosemide bolus, to either high-dose furosemide (HDF, 20 mg/h continuous infusion for 8 hours) or low-dose furosemide combined with low-dose dopamine (LDFD, furosemide 5 mg/h plus dopamine 5 μg kg −1 min −1 continuous infusion for 8 hours). Both strategies were compared for total diuresis, WRF (defined as a rise in serum creatinine of >0.3 mg/dL from baseline to 24 hours), electrolyte balance, and 60-day postdischarge outcomes. Mean hourly excreted urine volume (272 ± 149 mL in HDF vs 278 ± 186 mL in LDFD group; P = .965) and changes in dyspnea score (Borg index: −4.4 ± 2.1 in HDF group vs −4.7 ± 2.0 in LDFD group; P = .575) during the 8 hours of protocol treatment were similar in the two groups. WRF was more frequent in the HDF (n = 9; 30%) than in the LDFD group (n = 2; 6.7%; P = .042). Serum potassium changed from 4.3 ± 0.5 to 3.9 ± 0.4 mEq/L at 24 hours ( P = .003) in the HDF group and from 4.4 ± 0.5 to 4.2 ± 0.5 mEq/L at 24 hours ( P = .07) in the LDFD group. Length of stay and 60-day mortality or rehospitalization rates (all-cause, cardiovascular, and worsening HF) were similar in the two groups. Conclusions In ADHF patients, the combination of low-dose furosemide and low-dose dopamine is equally effective as high-dose furosemide but associated with improved renal function profile and potassium homeostasis. Clinical Trial Registration Information ClinicalTrials.gov Identifier: NCT00937092 ( http://clinicaltrials.gov/ct2/show/NCT00937092)

Fulminant enterovirus 71 infection: case report

A previously healthy 3-year-old boy presented with high-grade fever, dyspnoea, alteration of consciousness, tachycardia and shock. A few erythematous macules and papules were seen on his palms and soles. Echocardiogram showed poor left ventricular contraction. Cardiac enzymes and pro-B-type natriuretic peptide were elevated. Milrinone, low-dose dopamine and intravenous immunoglobulin were administered. The patient recovered after 5 days without cardiac or neurological sequelae. The serological results showed a four-fold rise of enterovirus 71. In children with severe EV71 infection, early recognition of cardiopulmonary involvement and aggressive treatment are crucial to successful management.

Revascularization Leads to Greater Reduction in Ischemia Than Medical Therapy in Patients With Left Ventricular Dysfunction and Stable Coronary Artery Disease

high-dose furosemide (HDF, IV furosemide 20 mg/h for 8 hours) or low-dose furosemide combined with low-dose dopamine (LDFD, IV furosemide 5 mg/h plus IV dopamine 5mg/ kg/min) and were categorized according to pretreatment with a BB to form 4 study groups: HDFBB(+), HDFBB( ), LDFDBB(+), and LDFDBB( ) (n5 8, 9, 16, 8, respectively) in order to compare the effects of each therapy on diuresis, perceived dyspnea, renal function, and 60-day post-discharge outcomes. Results: Urine volume/hour for the first 8 hours was similar in the 4 groups (HDFBB(+): 3186 81ml, HDFBB( ): 2276 96ml, LDFDBB(+): 403 6 440ml, LDFDBB( ): 274 6 165ml; p 5 0.51) as were the changes in perceived dyspnea assessed by the Borg index score (HDFBB(+): -4.1 6 2.9, HDFBB( ): -4.3 6 0.9, LDFDBB(+): -4.9 6 2.2, LDFDBB( ): -4.5 6 1.7; p 5 0.77). Worsening of renal function by various definitions was less commonly seen in the LDFD groups regardless beta-blocker pretreatment (Table). Length of stay and 60-day outcomes (all-cause, cardiovascular, non-cardiovascular, and due to worsening HF) were similar in the 4 groups. Conclusion: Pretreatment with a BB does not affect the diuretic and renoprotective effects of low-dose dopamine in patients hospitalized for ADHF.

The Renal Effects of Low-Dose Dopamine Infusion in Elderly Patients Hospitalized for Acute Decompensated Heart Failure

Background: Prior studies have shown that women admitted with acutely decompensated heart failure have higher left ventricular ejection fractions (LVEF) than their male counterparts. In this study, we sought to determine if other echocardiographic differences exist between men and women hospitalized with ADHF and if gender is predictive of hospital length of stay (LOS), readmission and mortality. Methods: We retrospectively studied 182 consecutive patients admitted with ADHF to a tertiary teaching hospital. Echocardiographic variables were recorded (blinded to gender) in addition to clinical characteristics and 6-month outcomes. Results: Compared to men, women had higher mean LVEF, smaller LVs and left atria (LA), thinner LV posterior wall thickness, higher transmitral E and A velocities, and less right ventricular (RV) systolic dysfunction. In contrast, the degree of mitral (MR) and tricuspid regurgitation (TR) and RV systolic pressure (RVSP) were similar in both sexes, as were hospital LOS, and readmission and death at six months. Continuous and categorical variables were analyzed using student’s t-test and chisquared test respectively. Conclusions: LOS and 6 month outcomes are similar in women and men despite the presence of a higher LVEF and less RV systolic dysfunction in women, suggesting that other parameters, probably affecting diastolic function, play a greater role in women and should be targeted in an attempt to improve clinical outcomes.

Beta-Blocker Pretreatment Does Not Affect the Renoprotective Effects of Low-Dose Dopamine in Patients with Acute Decompensated Heart Failure

Beta-Blocker Pretreatment Does Not Affect the Renoprotective Effects of Low-Dose Dopamine in Patients with Acute Decompensated Heart Failure

Strategies for a Safe Cirrhotic Liver Resection

Liver resection remains a complex surgical procedure. This procedure is more risky when performed on cirrhotic patients. To improve the results of liver resection, strategies for a safe cirrhotic liver resection should be worked out. Preoperative assessments include control of associated comorbidities to fulfill ASA class Ⅰ and Ⅱ, gastroduodenal endoscopy to detect the associated gastroesophageal varices and perioperative heparin-free hemodialysis in patients with end-stage renal diseases. The extent of liver resection is based on the indocyanine-green retention rate. Intraoperative assessments include routine use of intraoperative ultrasonography, liver parenchymal transaction under low central venous pressure and intermittent hepatic inflow blood occlusion, and a restrictive policy of blood transfusion. Concomitant splenectomy may be suggested in patients with hypersplenic thrombocytopenia. After operation, intravenous low-dose dopamine or dobutamine is recommended. Fresh frozen plasma or albumin may be infused to keep serum albumin level ＞3g/dl. A branch-chain amino-acid enriched solution is suggested after liver resection for positive nitrogen balance. Based on these strategies, the mortality of cirrhotic liver resection can be reduced to＜1%, and even 0%. Liver resection in a cirrhotic patient is no longer a risky operation. The indication for cirrhotic liver resection may be extended.

Clinical trials update from the Heart Failure Society of America Meeting 2009: FAST, IMPROVE‐HF, COACH galectin‐3 substudy, HF‐ACTION nuclear substudy, DAD‐HF, and MARVEL‐1

This article presents findings and a commentary on late-breaking trials presented during the meeting of the Heart Failure Society of America in September 2009. Unpublished reports should be considered as preliminary, since analyses may change in the final publication. The FAST trial showed somewhat better performance of intrathoracic impedance for prediction of deterioration in patients with heart failure (HF) when compared with daily weighing. The IMPROVE-HF study reported the benefits of education on the management of patients with systolic HF. Galectin-3 appeared a useful method for improving risk stratification of patients with chronic HF in a substudy of the COACH trial. A nuclear substudy of the HF-ACTION trial failed to demonstrate that resting myocardial perfusion imaging, a measure of myocardial scar and viability, was clinically useful. A small randomized controlled trial (DAD-HF) suggested that the use of low-dose dopamine in patients with acutely decompensated HF was associated with less deterioration in renal function and less hypokalaemia. The MARVEL-1 trial raises further concerns about the safety of myoblast transplantation in ischaemic HF.

Low-Dose Dopamine in Kidney Transplantation

Background The use of low-dose dopamine (LDD; 0.5–2.5 μg/kg/min) in kidney transplant recipients seeks to increase urine output, prevent arterial vasospasm, and reduce the incidence of acute tubular necrosis. The aim of this study was to evaluate the effect of LDD in the early postoperative period (12 hours) among kidney transplant recipients. Methods We studied all kidney transplant recipients admitted to the Intensive Care Unit (ICU) in the early postoperative period from January 2004 to December 2008. A total of 105 patients were retrospectively assigned to two groups: group A (n = 57) was treated with LDD and group B (n = 48), not treated with LDD. All patients otherwise received the same therapy. Blood sample analysis and kidney function were recorded at 0, 6, and 12 hours after admission. For each patient, we collected the following data: donor and transplant kidney features, recipient demographics, intraoperative events, hemodynamic and kidney function parameters in the ICU, and outcomes. Patients were followed for 6 months after ICU discharge. Results Hourly diuresis and kidney function parameters showed no significant difference between the groups. Significant differences between group A and group B were observed in heart rate (92.63 ± 14.18 vs 82.87 ± 13.5, respectively), hours of ICU length of stay (29.0 ± 17.42 vs 20.43 ± 7.35, respectively), and 6-month mortality rate (8.8% vs 0%, respectively; P < .05). Conclusion LDD prescription in kidney transplantation neither improved kidney function during the postoperative period nor short-term outcomes, but was associated with an increased heart rate, ICU length of stay and 6-month mortality.

Renoprotective and Potassium Sparing Effects of Low Dose Dopamine in Acute Decompensated Heart Failure: Preliminary Results of the Dopamine in Acute Decompensated Heart Failure (DAD-HF) Trial

Renoprotective and Potassium Sparing Effects of Low Dose Dopamine in Acute Decompensated Heart Failure: Preliminary Results of the Dopamine in Acute Decompensated Heart Failure (DAD-HF) Trial