Renal dopaminergic system: Pathophysiological implications and clinical perspectives

Table 2 Clinical studies providing evidence against/in support of clinical use of low dose dopamine

	Study design	Results	Ref.
Against clinical use of low dose dopamine	The Australian and New Zealand Intensive Care Society (ANZICS): multicenter, randomized, double-blind, placebo-controlled	324 patients with at least two criteria for the systemic inflammatory response syndrome and clinical evidence of early renal dysfunction: continuous intravenous infusion of low-dose dopamine (2 µg/kg per minute) did not attenuate the peak serum creatinine compared with placebo. There was no statistical difference in mortality between dopamine and placebo arms	Bellomo et al[119]
	Meta-analysis study: 17 studies were randomized clinical trials (n = 854)	Low dose dopamine administration did not prevent mortality or the onset of acute renal failure, or the need for haemodialysis in clinically ill patients	Kellum and M Decker[120]
	Meta-analysis study: 15 randomized controlled studies	Dopamine administration did not present beneficial results in terms of serum creatinine changes and incidence of acute renal failure in clinically ill patients	Marik[121]
	Sepsis Occurrence in Acutely Ill Patients (SOAP): Cohort, multiple-center, observational study	Dopamine administration in shock patients, compared to patients who did not receive it, was associated with 20% increase in ICU and hospital mortality rates	Sakr et al[122]
	Renal Optimization Strategies Evaluation (ROSE) study: multicenter, double-blind, placebo-controlled randomized clinical trial	Low dose dopamine (2 µg/kg per minute) did not enhance decongestion or improved renal function when added to diuretic therapy in 360 patients with acute heart failure and renal dysfunction	Chen et al[123]
In support of clinical use of low dose dopamine	Dopamine in Acute Decompensated Heart Failure (DAD-HF) Trial: randomized clinical trial	The addition of low-dose dopamine (5 μg/kg per minute) to low-dose furosemide (5 mg/h) was associated with improvement in renal function profile and potassium homeostasis at 24 h and it was equally effective as high-dose furosemide (20 mg/h) alone on subjective perception of dyspnoea in 60 patients with acute decompensated heart failure	Giamouzis et al[124]
	Retrospective clinical study	Continuous infusion of furosemide in addition to low-dose dopamine compared to intermittent boluses of furosemide was less nephrotoxic and carried a lower readmission rate at 30 d in 116 patients with acute decompensated heart failure	Aziz et al[125]
	A prospective single-center randomized double-blind placebo controlled trial	The treatment with high-dose fenoldopam at 1 μg/kg per minute (short-acting D1 agonist) during cardiopulmonary bypass in 80 pediatric patients undergoing cardiac surgery for congenital heart disease significantly decreased urinary biomarkers of acute kidney injury (urinary neutrophil gelatinase-associated lipocaline and cystatin C levels) and also reduced the incidence of acute kidney injury in the postoperative period and the use of diuretics and vasodilators	Ricci et al[126]
	Clinical case finding	Low doses of ANP (0.0125 μg/kg per minute) with low dose dopamine (1.0 μg/kg per minute) in acute decompensated heart failure increased urine output, decreased heart rate, improved congestion with a reduced brain natriuretic peptide level, reduced serum creatinine and the levels of urinary liver-type fatty acid binding protein -a novel reno-tubular stress marker- and 8-hydroxydeoxyguanosine -an oxidative stress marker	Kamiya[127]
	Prospective randomized clinical study	Low dose dopamine infusion reduces renal tubular injury following cardiopulmonary bypass in 48 patients with normal or near normal baseline renal function	Sumeray et al[128]