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Renal failure often manifests as oliguria. Many therefore view oliguria as a sinister development that should be prevented or treated in the hope of avoiding renal failure. However, oliguria can be a normal physiological response and, in itself, is a poor predictor of acute renal failure. 1 2 Nevertheless, dopamine infusions have gained popularity over the past 20 years as a means to prevent or treat oliguria.
Dopamine is usually infused at low to intermediate rates of 2-5 μg/kg/min. The perceived beneficial effects include increased cardiac output, improved renal perfusion, reduced tubular metabolic activity, diuresis, and natriuresis. Thus, dopamine is used in a variety of clinical settings to prevent or ameliorate renal injury or hasten restoration of renal function. 3 4 Cardiac failure and fluid overload have also been considered as indications for dopamine, although tachyphylaxis may limit these potential benefits. 4
Recently, there has been a greater focus on potential adverse effects. 5 Arrhythmias and myocardial, gut, and peripheral vascular ischaemia are well described. Other potential harmful effects include dopamine induced diuresis in the presence of volume depletion, pulmonary hypertension, impaired hypoxic ventilatory responses, decreased gastric motility, increased metabolic rate, and increased weight loss. Dopamine also causes endocrine and immune dysfunction, with reduced secretion of growth hormone, prolactin, and dehydroepiandosterone. 6
Reduced secretion of growth hormone may promote catabolism and impair immune responses. Hypoprolactinaemia and low dehydroepiandosterone also impair cellular immune responses...