Content area
Full text
The use of dopamine for prevention and treatment of acute renal failure is based on its ability to increase renal blood flow in animals 1 and in normal human subjects. 2 3 Early case reports 4 appeared to confirm the benefit of dopamine which has become widely used for the treatment of patients with acute renal failure. However, more recently the benefits of dopamine have been questioned, 5 and more attention given to its risks. 6 Denton et al 7 concluded that renal dose dopamine "should not be used for its selective renal vasodilatory actions in patients with acute renal failure until its efficacy is established conclusively." We have reviewed the published literature using a Medline search and tracing back references from recent publications to determine whether the current use of dopamine for management of acute renal failure can be justified by the currently available evidence.
The normal physiology of dopamine,
The effects of dopamine infusion are complex as it acts on a number of different receptors which have opposing actions. 3 Dopamine can stimulate [beta]1 -adrenoreceptors and increase cardiac index. 8 At high dose, dopamine interacts with peripheral [alpha]1 -adrenoreceptors to bring about systemic vasoconstriction. 9 In addition, there are two major subgroups of dopamine receptors. DA1 Receptors have been demonstrated on renal, mesenteric, coronary and cerebral arteries, 10 while DA2 receptors are located in autonomic ganglia and sympathetic nerve endings where they inhibit noradrenaline release 11 ; they also inhibit aldosterone production in the adrenal gland. 10 Given the complexity of dopamine's actions it is unsurprising that there is overlap of the doses at which its various effects are seen and no dose is specifically renal in action. 12
In normal animals, dopamine infusion increases renal blood flow, although this is dose-dependent and the dose range varies between species. 13 In man, low- dose dopamine (0.5-3.0 [mu]g/kg/min) increases renal blood flow, measured usingp -aminohippuric acid clearance, 2 by stimulation of DA1 receptors. 14 In normal dogs low-dose dopamine results in an increase in glomerular filtration rate (GFR). 10 Evidence of a change in GFR in man is conflicting. McDonald et al 2 found an increase in inulin clearance from 109 to 126 ml/min with dopamine infused...