Effect of Postoperative Low-Dose Dopamine on Renal Function after Elective Major Vascular Surgery

Baldwin, Lee; Henderson, A; Hickman, Peter E.

doi:10.7326/0003-4819-120-9-199405010-00004

Cited by 139 publications

(26 citation statements)

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“…Indeed, some efforts have already been made to prevent AKI associated with aortic aneurysms repair, mostly with conflicting and sometimes disappointing results. [23][24][25][26][27] Nevertheless, we found other risk factors for mortality that are also potentially suitable for intervention. We confirmed in this study that serum glucose levels higher than 118 mg/dL, even transiently within 48 h after operation, are strongly associated with increases in mortality.…”

Section: E Macedo Et Almentioning

confidence: 93%

Impact of Mild Acute Kidney Injury (AKI) on Outcome after Open Repair of Aortic Aneurysms

Macedo

Castro

et al. 2008

Renal Failure

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Recently, mild AKI has been considered as a risk factor for mortality in different scenarios. We conducted a retrospective analysis of the risk factors for two distinct definitions of AKI after elective repair of aortic aneurysms. Logistic regression was carried out to identify independent risk factors for AKI (defined as Ն25% or Ն50% increase in baseline SCr within 48 h after surgery, AKI 25% and AKI 50%, respectively) and for mortality. Of 77 patients studied (mean age 68 ± 10, 83% male), 57% developed AKI 25% and 33.7% AKI 50%. There were no differences between AKI and control groups regarding comorbidities and diameter of aneurysms. However, AKI patients needed a supra-renal aortic cross-clamping more frequently and were more severely ill. Overall in-hospital mortality was 27.3%, which was markedly higher in those requiring a supra-renal aortic cross-clamping. The risk factors for AKI 25% were suprarenal aortic cross-clamping (odds ratio 5.51, 95% CI 1.05-36.12, p = 0.04) and duration of operation for AKI 25% (OR 6.67, 95% CI 2.23-19.9, p < 0.001). For AKI 50%, in addition to those factors, post-operative use of vasoactive drugs remained as an independent factor (OR 6.13, 95% CI 1.64-22.8, p = 0.005). The risk factors associated with mortality were need of supra-renal aortic cross-clamping (OR 9.6, 95% CI 1.37-67.88, p = 0.02), development of AKI 50% (OR 8.84, 95% CI 1.31-59.39, p = 0.02), baseline GFR lower than 49 mL/min (OR 17.07, 95% CI 2.00-145.23, p = 0.009), and serum glucose > 118 mg/dL in the post-operative period (OR 19.99, p = 0.006). An increase of at least 50% in baseline SCr is a common event after surgical repair of aortic aneurysms, particularly when a supra-renal aortic cross-clamping is needed. Along with baseline moderate chronic renal failure, AKI is an independent factor contributing to the high mortality found in this scenario.

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Section: E Macedo Et Almentioning

confidence: 93%

Impact of Mild Acute Kidney Injury (AKI) on Outcome after Open Repair of Aortic Aneurysms

Macedo

Castro

et al. 2008

Renal Failure

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“…Since dopamine was first synthesized in 1910, a large amount of research related to this drug has allowed identification of its effects and mechanism of action, 2,8,20 and also definition of its therapeutic possibilities. The idea that LDD could prevent acute renal failure arose naturally from knowledge of its selective renal vasodilatory properties.…”

Section: Discussionmentioning

confidence: 99%

“…3,6,[8][9][10][11] Studies with animals 12 and acute renal failure patients 8,9,[13][14][15][16][17] have not shown evidence that LDD maintained or improved renal function. Thus, if proven inadequate, continued injection of LDD would result only in potential additional medical treatment, 18 thereby increasing the costs.…”

Section: Introductionmentioning

confidence: 99%

Hemodynamics and renal function during administration of low-dose dopamine in severely ill patients

et al. 2004

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CONTEXT: Although a large number of studies have been performed regarding the renal and hemodynamic effects of the infusion of low-dose dopamine (LDD) in severely ill patients, there is still controversy on this subject. OBJECTIVE: To evaluate the effects of dopamine (2 mug/kg/min) on systemic hemodynamics (lowest mean arterial pressure, MAP, highest heart rate, HR, central venous pressure, CVP), creatinine clearance (CLcr), diuresis and fractional sodium excretion (FENa+). TYPE OF STUDY: A non-randomized, open, prospective clinical trial. SETTING: An intensive care unit in a tertiary university hospital. PARTICIPANTS: 22 patients with hemodynamic stability admitted to the intensive care unit. PROCEDURES: Patients were submitted to three two-hour periods: without dopamine (P1), with dopamine (P2) and without dopamine (P3). MAIN MEASUREMENTS: The abovementioned variables were measured during each period. CLcr was assessed based upon the formula U x V/P, where U is urinary creatinine (mg/dl), V is diuresis in ml/min and P is serum creatinine (mg/dl). FENa+ was calculated based upon the formula: urinary sodium (mEq/l) x P/plasma sodium (mEq/l) x U) x 100. Results were presented as mean and standard deviation. The Student t test was used and results were considered significant if p was less than 0.05. RESULTS: Twelve patients (seven males and five females) were included, with a mean age of 55.45 years. There was no significant variation in MAP, HR, CVP, CLcr or FENa+ with a dopamine dose of 2 mug/kg/min. On the other hand, diuresis significantly increased during P2, from 225.4 to 333.9 ml. CONCLUSION: Infusion of 2 mug/kg/min of dopamine for 2 hours increases diuresis. At the doses studied, dopamine does not induce significant alterations in MAP, HR, CVP, CLcr and FENa+.

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“…A randomized, controlled trial of low-dose dopamine in critically ill patients has failed to demonstrate a renal-sparing effect [60]. In sepsis, renal vascular autoregulation and vasodilation may already be at a maximum and not amenable to pharmacological vasodilation [61].…”

Section: Figmentioning

confidence: 99%

“…In sepsis, renal vascular autoregulation and vasodilation may already be at a maximum and not amenable to pharmacological vasodilation [61]. Dopamine blunts hypoxic ventilatory drive, may increase pulmonary shunting in critically ill patients, and can cause digital necrosis, even in low doses [60,62]. Therefore, widespread use of dopamine to "protect" specific vascular beds such as the splanchnic circulation and kidney may result, ironically, in deleterious consequences.…”

Section: Figmentioning

confidence: 99%

Direct Effects of Dopamine on Colonic Mucosal pH: Implications for Tonometry

Winter¹,

O’Sullivan²,

Harvey³

et al. 1999

Journal of Surgical Research

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Effect of Postoperative Low-Dose Dopamine on Renal Function after Elective Major Vascular Surgery

Abstract: Within the limits of the small size of the study, low-dose dopamine appeared to offer no advantage to euvolemic patients after elective abdominal aortic surgery. However, patients with acute oliguric renal failure were not included in the study.

Cited by 139 publications

References 0 publications

Impact of Mild Acute Kidney Injury (AKI) on Outcome after Open Repair of Aortic Aneurysms

Impact of Mild Acute Kidney Injury (AKI) on Outcome after Open Repair of Aortic Aneurysms

Hemodynamics and renal function during administration of low-dose dopamine in severely ill patients

Direct Effects of Dopamine on Colonic Mucosal pH: Implications for Tonometry

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