Lack of renoprotective effects of dopamine and furosemide during cardiac surgery

• Published in: Journal of the American Society of Nephrology Vol. 11; no. 1; pp. 97 - 104
• Main Authors: LASSNIGG, A, DONNER, E, GRUBHOFER, G, PRESTERL, E, DRUML, W, HIESMAYR, M
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 2000
• Subjects: Acute Kidney Injury - etiology; Acute Kidney Injury - prevention & control; Adult; Aged; Analysis of Variance; Biological and medical sciences; Cardiac Surgical Procedures - adverse effects; Cardiotonic Agents - administration & dosage; Diuretics - administration & dosage; Dopamine - administration & dosage; Double-Blind Method; Female; Furosemide - administration & dosage; Humans; Infusions, Intravenous; Intraoperative Period; Kidney Function Tests; Male; Medical sciences; Middle Aged; Pharmacology. Drug treatments; Preoperative Care; Reference Values; Treatment Failure; Treatment Outcome; Urinary system; Kidney disease; Heart; Human; Cardiotonic agent; Chemoprophylaxis; Urinary system disease; Dopamine; Treatment efficiency; Cardiovascular disease; Furosemide; Diuretic; Surgery; Renal failure
• ISSN: 1046-6673; 1533-3450
• DOI: 10.1681/asn.v11197

Because development of acute renal failure is one of the most potent predictors of outcome in cardiac surgery patients, the prevention of renal dysfunction is of utmost importance in perioperative care. In a double-blind randomized controlled trial, the effectiveness of dopamine or furosemide in prevention of renal impairment after cardiac surgery was evaluated. A total of 126 patients with preoperatively normal renal function undergoing elective cardiac surgery received a continuous infusion of either "renal-dose" dopamine (2 microg/kg per min) (group D), furosemide (0.5 microg/kg per min) (group F), or isotonic sodium chloride as placebo (group P), starting at the beginning of surgery and continuing for 48 h or until discharge from the intensive care unit, whichever came first. Renal function parameters and the maximal increase of serum creatinine above baseline value within 48 h (deltaCrea(max)) were determined. The increase in plasma creatinine was twice as high in group F as in groups D and P (P < 0.01). Acute renal injury (defined as deltaCreamax) >0.5 mg/dl) occurred more frequently in group F (six of 41 patients) than in group D (one of 42) and group P (zero of 40) (P < 0.01). (The difference between group D and group P was not significant.) Creatinine clearance was lower in group F (P < 0.05). Two patients in group F required renal replacement therapy. The mean volume of infused fluids, blood urea nitrogen, serum sodium, serum potassium, and osmolar- and free-water clearance was similar in all groups. It was shown that continuous infusion of dopamine for renal protection was ineffective and was not superior to placebo in preventing postoperative dysfunction after cardiac surgery. In contrast, continuous infusion of furosemide was associated with the highest rate of renal impairment. Thus, renaldose dopamine is ineffective and furosemide is even detrimental in the protection of renal dysfunction after cardiac surgery.