Use Of Low-dose Dopamine Research Articles

Circulatory Effects of Peripheral Chemoreflex Inhibition During Exercise in Treated Hypertension

The sensitization of the peripheral (carotid) chemoreflex can cause a sympathetically mediated restraint of blood flow to the exercising muscles in some disease states (e.g., heart failure, COPD). Such impairments in nutritive blood flow have the potential to impair exercise tolerance and raise exercising blood pressure (BP). Increased peripheral chemoreflex sensitivity and pronounced exercise-induced surges in BP have been reported in hypertension. Herein, we tested the hypothesis that suppressing peripheral chemoreflex sensitivity improves skeletal muscle blood flow during exercise in hypertension. Fourteen patients with treated hypertension (age 69±11 years, systolic BP 136±12 mmHg, diastolic BP 80±11 mmHg; mean ± SD) performed a resting baseline (3 min), an isocapnic hypoxia rebreathing test and rhythmic handgrip exercise (3 min at 50% of maximal voluntary contraction, 1 s contraction and 2 s relaxation) with either intravenous 0.9% saline (control) or low-dose dopamine (2 mcg·kg−1·min−1) to inhibit the peripheral chemoreflex. BP (finger plethysmography), heart rate (HR; electrocardiogram) and ventilation (V̇E; heated pneumotachometer) were recorded throughout. Brachial artery blood flow was monitored (duplex Doppler ultrasound) at rest (1 min average) and during handgrip (15 s averages), and vascular conductance calculated as brachial blood flow/mean BP. Dopamine blunted the peak (last 15 s) increase in V̇E during isocapnic hypoxic rebreathing compared to saline infusion (Δ6±6 vs. Δ9±5 L·min−1, P=0.026), while also attenuating peak mean BP (Δ3±4 vs. Δ8±6 mmHg, P=0.007). Dopamine did not change resting mean BP (95±10 vs. 98±10 mmHg, P=0.155) and HR (68±7 vs. 66±8 beats·min−1, P=0.100). However, dopamine increased resting brachial blood flow (59±20 vs. 48±16 mL·min−1, P=0.030) and vascular conductance (0.565±0.246 vs. 0.483±0.160 mL·min−1·mmHg−1, P=0.039) and decreased resting V̇E (10.5±3.2 vs. 11.5±3.1 L·min−1, P=0.036) versus saline. Handgrip increased brachial artery blood flow (p<0.05 vs. rest after 45 s), vascular conductance (p<0.05 vs. rest after 45 s) in both saline and dopamine trials, while mean BP, HR and V̇E were unchanged (main effect of time P=0.829, P=0.954 and P=0.255, respectively). Notably, brachial artery blood flow (e.g., Δ76±54 vs. Δ60±43 mL·min−1 at 60 s) and vascular conductance (e.g., Δ0.730±0.440 vs. Δ0.570±0.424 mL·min−1·mmHg−1 at 60 s) responses to handgrip were greater with dopamine than saline (main effect of condition both p<0.0001). Collectively, these findings indicate that the use of low-dose dopamine to suppress peripheral chemoreflex sensitivity improves skeletal muscle blood flow during rhythmic handgrip exercise in patients with treated hypertension. Funding support provided by the Health Research Council of New Zealand (19/687) and the Sidney Taylor Trust. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Use of Low Dose Dopamine in Heart Failure with Preserved Ejection Fraction Patients with Right Ventricular Dysfunction

Right ventricular dysfunction (RVD) is associated with poor outcomes in heart failure with preserved ejection fraction (HFpEF) and serves as an important therapeutic target. Though treatment with low-dose dopamine (DA) has not shown benefit decompensated HF, we sought to evaluate the effect of DA on HFpEF patients with RVD (HFpEF-RVD), which is currently is unknown. We analyzed subjects enrolled in the Randomized Evaluation of Heart Failure With Preserved Ejection Fraction Patients With Acute Heart Failure and Dopamine trial (NCT01901809) for the presence of RVD and compared clinical outcomes based on treatment with DA. RVD was defined by ≥1 trait on echocardiography: tricuspid annular plane systolic excursion <1.7 cm, fractional area change <35%, tissue Doppler imaging velocity (S') <10 cm/s, or semi-quantitative visual assessment of RVD. Bivariable analysis was performed using median tests for continuous variables and chi-square tests for categorical variables. Multivariable logistic regression was performed to assess for predictors of RVD in our cohort. RVD was present in 29% (24 of 82) of our cohort. HFpEF-RVD patients had lower BMI (34 kg/m2 [14.6] v 42 kg/m2 [14.2], p=0.01), higher Cr (1.4 mg/dL [0.6] v 1.2 mg/dL [1], p=0.01), and higher NT-proBNP (2327 pg/mL [3260] v 1425 pg/mL [2370], p=0.002) compared to HFpEF-no RVD. BMI was inversely associated with HFpEF-RVD after adjustment for age, sex, and race (p=0.02). HFpEF-RVD had increased 30-D hospital readmission (35% v 19%, p=0.12) and worse survival at 1 year (70% v 88%, p=0.06), though not statistically significant. DA had no significant effect on renal function in HFpEF-RVD; however, the presence of RVD positively modified the effect of DA on length of stay (LOS) (p=0.01, Figure). HFpEF-RVD reflects a sicker subgroup of HFpEF patients. In hospitalized HFpEF, low-dose DA was associated with shorter LOS in HFpEF-RVD. Future studies should be performed to find useful therapies in HFpEF-RVD.

Early fluid overload predicts higher non-relapse and overall mortality in adults after single-unit cord blood transplantation.

Early fluid overload has been associated with poor transplant outcomes after allogeneic hematopoietic cell transplantation. However, its effects on the outcomes after cord blood transplantation (CBT) are unclear. We retrospectively analyzed the data of 227 adult patients who received single-unit CBT in our institute. The cumulative incidence of grade ≥2 fluid overload was 4% at day 30 after CBT with a median onset at 16 days (range, 9-30 days) after CBT. In the multivariate analysis, grade ≥2 fluid overload was significantly associated with higher non-relapse mortality (hazard ratio [HR], 5.73; P = 0.011) and overall mortality (HR, 3.81; P = 0.006). Among the entire cohort, 133 patients were treated with low-dose dopamine (0.5-2 µg/kg/min) with a median time of initiation of low-dose dopamine therapy at 10.5 days after CBT. Use of low-dose dopamine significantly increased daily urine output and decreased body weight. These data suggested that early fluid overload was significantly associated with non-relapse and overall mortality after single CBT. The early intervention of low-dose dopamine to prevent early fluid overload is a matter of future investigation for patients undergoing allogeneic hematopoietic cell transplantations (HCT), particularly for CBT.

Use of Low-Dose Dopamine in Heart Failure with Preserved Ejection Fraction Patients with Right Ventricular Dysfunction

Introduction Heart failure with preserved ejection fraction (HFpEF) constitutes half of HF hospitalizations in the U.S. Right ventricular dysfunction (RVD) is associated with high morbidity and mortality in HFpEF and serves as an important therapeutic target. The use of low-dose dopamine (DA) has not shown benefit in the treatment of decompensated HF patients; however, the effect of DA on HFpEF patients with RVD (HFpEF-RVD) is unknown. Methods We analyzed subjects enrolled in the Randomized Evaluation of Heart Failure With Preserved Ejection Fraction Patients With Acute Heart Failure and Dopamine trial (ROPA-DOP; NCT01901809) for the presence of RVD and compared clinical outcomes based on treatment assignment to DA. ROPA-DOP was a randomized controlled trial of low-dose DA for the treatment of acute decompensated HFpEF. RVD was defined as at least 1 of the following by echocardiography: tricuspid annular plane systolic excursion Results RVD was present in 29% (24 of 82) of patients enrolled in the ROPA-DOP trial. HFpEF-RVD patients had lower BMI (34 kg/m2 [14.6] v 42 kg/m2 [14.2], p=0.01), higher Cr (1.4 mg/dL [0.6] v 1.15 mg/dL [1], p=0.01), higher admission NT-proBNP (2327 pg/mL [3260] v 1425 pg/mL [2370], p=0.002), and more atrial fibrillation (54% v 29%, p=0.03) compared to HFpEF without RVD. BMI remained inversely associated with HFpEF-RVD after adjustment for age, sex, and race (p=0.02). HFpEF-RVD trended towards increased all-cause 30-D hospital readmission (34.8% v 19%, p=0.12) and worse survival at 1 year (70% v 87.5%, p=0.06). DA had no significant effect on urine output, weight change, or renal function in HFpEF-RVD; however, DA was associated with shorter hospital length of stay (LOS) in HFpEF-RVD in testing for interaction effects between RVD and DA (p=0.01, Figure). Conclusion HFpEF-RVD reflects a sicker subgroup of HFpEF patients. Amongst hospitalized HFpEF, low-dose dopamine was associated with shorter LOS in HFpEF-RVD. Future studies should be performed to find useful therapies in this subgroup of HFpEF.

Clinical practice guidelines for the provision of renal service in Hong Kong: General Nephrology.

Clinical practice guidelines for the provision of renal service in Hong Kong: General Nephrology.

Dopamine in transplantation: Written off or comeback with novel indication?

Renal-dose dopamine has fallen out of favor in the intensive care unit (ICU) during past years due to its ineffectiveness to prevent impending or to ameliorate overt renal failure in the critically ill. By contrast, growing evidence indicates that low-dose dopamine administered to the stable organ donor after brain death confirmation improves the clinical course of transplanted organs after kidney and heart transplantation. Ensuring a thorough monitoring for potential circulatory side effects, employment of dopamine at a dose of 4μg/kg/min is safe in the deceased donor. Among recipients, the advantageous effect is easy to achieve, inexpensive, and devoid of adverse side effects. The mode of action relies on dopamine's propensity to mitigate injury in various cell systems from isolated transplantable organs under cold storage conditions. The present review article summarizes the clinical evidence of dopamine donor pretreatment in solid organ transplantation and focuses on the underlying molecular mechanisms of cellular protection. Introducing the routine use of low-dose dopamine for the management of the brain-dead donor in the ICU before procurement provides an evidence-based strategy to improve graft outcome after kidney transplantation without conferring harm to non-renal grafts, namely to livers and hearts, in cases of multi-organ donation.

Systemic effects of low-dose dopamine during administration of cytarabine.

Purpose Low-dose dopamine has been utilized to improve renal blood flow, urine output, and reduce drug-induced nephrotoxicity. The purpose of this study was to assess changes in renal function, cardiovascular adverse events, and neurologic toxicity in patients receiving cytarabine with or without low-dose dopamine. Methods A retrospective, single-center, cohort study of patients receiving cytarabine at 667 mg/m2/dose or greater, with or without dopamine at ≤5 mcg/kg/min. Cohorts were based upon initiation or absence of low-dose dopamine; cytarabine only, cytarabine + pre- and day of low-dose dopamine, and cytarabine + post-low-dose dopamine. Renal outcomes (urine output, serum creatinine, and creatinine clearance) were compared with baseline and between cohorts. Safety endpoints (arrhythmias, tachycardia, and neurotoxicity) were compared between cohorts based on low-dose dopamine exposure. Results There was no difference in urine output from baseline in all cohorts. Comparing cytarabine only and pre- and day of low-dose dopamine cohorts, there was no difference in urine output. In those receiving low-dose dopamine, there was no difference in serum creatinine and creatinine clearance from baseline. No arrhythmias were documented during the study period, and there was no difference in the incidence of tachycardia between groups (P = 0.66). Neurotoxicity was reported in three patients who were on low-dose dopamine. Conclusion Though variation existed in individual patients administered low-dose dopamine, the use of low-dose dopamine did not significantly impact renal function in this small sample at a single institution. In addition, low-dose dopamine did not negatively impact cardiovascular function.

Is there still a role for low-dose dopamine use in acute heart failure?

Acute heart failure (AHF) is a major health problem worldwide, with no proven therapy. Low-dose dopamine has been used in this entity to improve renal outcomes in the past decades. The aim of this article is to review the former and recent clinical trials about the use of low-dose dopamine in AHF. The Dopamine in Acute Decompensated Heart Failure II study enrolled 161 patients with AHF and found no improvement in clinical outcomes with the addition of dopamine. Similarly, the Renal Optimization Strategies Evaluation in Acute Heart Failure trial, which included 360 patients with AHF and renal dysfunction, evaluated the efficacy of 72-h infusion of either low-dose nesiritide or low-dose dopamine versus placebo in addition to standardized diuretic treatment. No differences were found between both treatment groups and placebo with regard to the coprimary endpoints of cumulative urine volume and change from baseline in plasma cystatin C. On the basis of the current data, there is no role for the routine use of low-dose dopamine in nonhypotensive patients with AHF. Further studies are needed to define the role of low-dose dopamine in patients with AHF and hypotension. Until the availability of more data, the use of dopamine in AHF should be individualized.

Alternativas al tratamiento diurético convencional en insuficiencia cardíaca

Although treatment of acute heart failure is based primarily on the administration of intravenous loop diuretics, evidence supporting this practice is still scarce and there is uncertainty about the optimal dose. The existence of a considerable percentage of patients refractory to diuretic therapy and worsening of renal failure associated with the use of these drugs, with possible implications for medium-term mortality, have prompted the search for more effective and safer alternatives. Extracorporeal purification techniques, such as ultrafiltration, have demonstrated efficacy, although their superiority is unclear, due to the possible adverse effects associated with the procedure. The use of low-dose dopamine is not superior to conventional diuretic therapy after the first few hours of treatment. Moreover, combination with furosemide and hypertonic saline could be a valid alternative for patients with refractory congestion and depressed ejection fraction and serum creatinine ≤ 2.5mg/dL, but further studies are needed before its widespread use. The use of tolvaptan may be an effective alternative in the short-term but its use may be limited by its price. There is still controversy about whether treatment with loop diuretics is associated with higher mortality in all groups of patients with HF exacerbations. These controversies should be clarified by future clinical trials.

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.

Evidence-Based Practice Habits: Transforming Research Into Bedside Practice

Evidence-Based Practice Habits: Transforming Research Into Bedside Practice

Use of low dose dopamine, gabexate mesilate and ulinastatin reduces the water balance and pulmonary complication in thoracic esophagectomy patients

In spite of improvements in surgical technique and perioperative care, severe lung complication remains as the leading cause of morbidity in thoracic esophageal cancer patients who undergo esophagectomy. The purpose of this study was to evaluate the safety and effectiveness of postoperative drug therapy using low dose dopamine, gabexate mesilate, and ulinastatin on postoperative lung complication in esophageal cancer patients. Sixty-one patients operated for esophageal cancer from 1996 to 2000 were treated postoperatively with low dose dopamine (300 microg/kg/h), gabexate mesilate (80 mg/h), and ulinastatin (300 000 unit/day) as a study group. Seventy-four patients operated from 1987 to 1994 served as an historical control group. Various preoperative and perioperative medical parameters and water balance were analyzed. Postoperative pulmonary complications were observed in 26 patients (35.1%) in the control group and three patients (4.9%) in the study group, respectively (P < 0.0001). Preoperative and perioperative variables were not significantly different between the groups. Water balance from operation to postoperative day 3 in the study group was significantly lower than the control group. Postoperative use of low dose dopamine, gabexate mesilate, and ulinastatin significantly reduced pulmonary complications after esophagectomy. This may be partly attributable to negative water balance during the early postoperative days.

Low dose (renal dose) dopamine in the critically ill patient

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether low dose (renal dose) dopamine in the critically ill patient prevents acute renal failure. Altogether 141 papers were found using the reported search, of which three presented the best evidence to answer the clinical question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these papers are tabulated. We conclude that there is no evidence to support the use of low-dose dopamine to treat acute renal failure in critically ill patients.

Changes in Renal Function by Low Dose Dopamine in Patients Undergoing Hepatectomy with Low Central Venous Pressure Maintenance

Background: The maintenance of low central venous pressure (LCVP) induced by fluid restriction and nitroglycerin administration reduces the overall blood loss during major hepatic resections. We studied the postoperative renal function in hepatectomized patients under LCVP maintenance with nitroglycerin. In addition, the renal effect of low dose dopamine combined with nitroglycerin was evaluated. Methods: A total of 60 patients were randomly divided into two groups: a nitroglycerin group (n = 30), and a nitroglycerin and dopamine group (n = 30). During the Pringle maneuver the central venous pressure (CVP) was maintained at /kg/min nitroglycerin before and during the Pringle maneuver, but in nitroglycerin and dopamine group, 3/kg/min dopamine was administered with nitroglycerin. Mean arterial pressure, CVP, and urine output were measured before, during, and after the Pringle maneuver. BUN and serum creatinine were measured on postoperative days 1 and 3. Results: No significant differences were observed between the mean arterial pressures, CVPs, or urine outputs of the two groups. In both groups, urine output reduced after the Pringle maneuver but increased more in the nitroglycerin and dopamine group than in the nitroglycerin control group after anesthesia. There was no overall statistical change in either BUN or creatinine in either group. Conclusions: We conclude that LCVP induced by nitroglycerin with the Pringle maneuver during hepatectomy does not cause postoperative renal dysfunction, and that the use of low dose dopamine with nitroglycerin has no meaning in terms of preventing renal dysfunction in this situation.

Cardiac anaesthesia: the last 10 years.

Cardiac anaesthesia: the last 10 years.

Dopamine and kidney in sepsis: a systematic review

Acute renal failure has a high morbidity and mortality in critically ill patients. Severe sepsis and septic shock are important risk factors for the development of acute renal failure. Low-dose dopamine (0.5 to 3 mg/kg/min) has been used for decades as a renal-protective therapy in such patients, even in the absence of any controlled study to support this concept. To Check the literature for evidences supporting the routine use of low-dose dopamine in severe sepsis and septic shock. Systematic review of the literature, on electronic databasis (MEDLINE, EMBASE and LILACS), and handsearching. Only five randomized clinical trials were found, but none of them studied renal outcomes. Eight cases series studies were included on a qualitative review. Dopamine was associated with some adverse effects, such as increase in pulmonary shunting, tachyarrhythmias, and increase in pulmonary artery pressure, that were not statistically significant. Mortality also did not change with the use of dopamine. There are no sufficient evidences in the literature to support the routine use of low-dose dopamine as a renal protective agent in severe sepsis and septic shock.

Understanding renal dose dopamine.

Low-dose dopamine is a widely administered drug used often in critical care settings to prevent or treat patients with low urinary output. There are new data to support that low-dose dopamine may have side effects and not always increase renal perfusion to the kidneys. This article is a review of the current use of low-dose dopamine, the role of dopamine in the kidneys, and the potential risks of infusing this drug to patients.

Use of dopamine in acute renal failure: a meta-analysis.

To determine whether low-dose dopamine administration reduces the incidence or severity of acute renal failure, need for dialysis, or mortality in patients with critical illness. We performed a MEDLINE search of literature published from 1966 to 2000 for studies addressing the use of dopamine in the prevention and/or treatment of renal dysfunction. Data were abstracted regarding design characteristics, population, intervention, and outcomes. Results of individual randomized clinical trials were pooled using a fixed effects model and a Mantel-Haenszel weighted chi-square analysis. We identified a total of 58 studies (n = 2149). Of these, outcome data were reported in 24 studies (n = 1019) and 17 of these were randomized clinical trials (n = 854). Dopamine did not prevent mortality, (relative risk, 0.90 [0.44-1.83]; p =.92), onset of acute renal failure (relative risk, 0.81 [0.55-1.19]; p =.34), or need for dialysis, (relative risk, 0.83 [0.55-1.24]; p =.42). There was sufficient statistical power to exclude any large (>50%) effect of dopamine on the risk of acute renal failure or need for dialysis. The use of low-dose dopamine for the treatment or prevention of acute renal failure cannot be justified on the basis of available evidence and should be eliminated from routine clinical use.

Therapeutic Options for the Treatment of Impaired Gut Function

Abstract. Tissue hypoxia, especially in the splanchnic area, is still considered to be an important cofactor in the pathogenesis of multiple organ failure. Therefore, the specific effects of the various therapeutic interventions on splanchnic perfusion and oxygenation are of particular interest. Restoring and maintaining oxygen transport and tissue oxygenation is the most important step in the supportive treatment of patients with sepsis and impaired gut perfusion. Therefore, supportive treatment should be focused on an adequate volume resuscitation and appropriate use of vasoactive drugs. Adequate volume loading may be the most important step in the treatment of patients with septic shock. An elevated oxygen delivery may be beneficial in some patients, but the increase of oxygen delivery should be guided by the measurement of parameters assessing global and regional oxygenation. Forcing an elevation in oxygen delivery by the use of very high dosages of catecholamines can be harmful. Vasopressors should be used for achieving an adequate perfusion pressure. For norepinephrine, no negative effects on gut perfusion have been demonstrated. Epinephrine and dopamine should be avoided because they seem to redistribute blood flow away from the splanchnic region. There are no convincing data yet to support the routine use of low-dose dopamine or dopexamine to improve an impaired gut perfusion. There is even evidence that low-dose dopamine may reduce the mucosal perfusion in the gut in some patients. It has been suggested that dopexamine can improve splanchnic perfusion, but because these effects remain somewhat controversial, a general recommendation for dopexamine to improve gut perfusion is not justified.