In current medical practice, clinicians continue to grant dopamine widespread use in an attempt to prevent or ameliorate renal insufficiency. This practice receives criticism with the lack of prospective, large, randomized studies that show a permanent, positive outcome when low-dose “renal” dopamine (LDRD) has been used. Figure 1 identifies publications that discuss dopamine, and Figure 2 identifies those that discuss dopamine plus dopaminergic agents. Clinical dopamine studies continue to conclude that “further randomized prospective clinical trials are needed to evaluate if dopamine has a beneficial effect on renal preservation.”

Proponents of dopamine for renal preservation postulate beneficial effects to be reversal or prevention of oliguric acute renal failure (ARF), obviate or reduce the need for dialysis, provide a level of renal hemodynamic function unachievable by other means, and increase patient survival.<sup>24 DiBona G.F. Hemodynamic support: Volume management and pharmacological cardiovascular support Semin Nephrology 1994 ;  14 : 33-40

Cliccare qui per andare alla sezione Riferimenti</sup> Critics of studies using dopamine to maintain or improve renal viability raise several questions: Is an increase in urine output related to dopamine infusion or was it spontaneous? Was an increase in urine output secondary to increased cardiac output, selective redistribution of renal blood flow (RBF) (cortical > medullary), or a direct tubular-inhibition effect on Na⁺ reabsorption? Does an increased urine output actually protect the kidney? These many questions are yet to be fully answered about the practice of using LDRD therapy.

ARF affects approximately 5% of all general hospital patients and continues to be associated with a greater than 50% mortality despite major developments in medicine, surgery, and critical care management over the last 30 years.<sup>2 Alkhunaizi A.M., Schrier R.W. Management of acute renal failure: New perspectives Am J Kidney Dis 1996 ;  28 : 315-328  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 3 Anderson R.J., Schrier R.W. Acute tubular necrosis Diseases of the Kidney Boston: Little, Brown (1993).  1287-1318

Cliccare qui per andare alla sezione Riferimenti, 45 Harper L., Savage C.O. The use of dopamine in acute renal failure Clin Nephrology 1997 ;  47 : 347-349

Cliccare qui per andare alla sezione Riferimenti</sup> Hospital-acquired renal failure is reported to increase the relative risk of death by 6.2-fold.<sup>88 Shusterman N., Strom B.L., Murray T.G. , e al. Risk factors and outcome of hospital-acquired acute renal failure Am J Med 1987 ;  83 : 65  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> These impressive statistics continue to influence health care providers to utilize dopamine therapy to improve patient outcome in ARF without convincing evidence of a beneficial effect. This unproven practice will predictably continue unless scientific studies overall demonstrate a detrimental outcome with dopamine administration.

Studying the potential benefit of LDRD is difficult. ARF has multiple etiologies, occurs in multiple clinical settings, and has more than one form (i.e., prerenal, oliguric vs. nonoliguric, and postrenal).<sup>2 Alkhunaizi A.M., Schrier R.W. Management of acute renal failure: New perspectives Am J Kidney Dis 1996 ;  28 : 315-328  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> Initiation of dopamine therapy before a potential occurrence of ARF, with established ARF, or in patients with pre-existing renal disease are variables that influence outcome studies.