Meta-Analysis: Low-Dose Dopamine Increases Urine Output but Does Not Prevent Renal Dysfunction or Death

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Abstract
Surveys have documented the continued popularity of low-dose dopamine to influence renal dysfunction even though few data support it and editorials and reviews have discouraged its use. To evaluate the effects of low-dose dopamine (≤5 µg/kg of body weight per minute) compared with placebo or no therapy in patients with or at risk for acute renal failure. MEDLINE (1966–January 2005), EMBASE (1980–week 5, 2005), CANCERLIT (1975–2002), CINAHL (1982–January 2005), and CENTRAL (The Cochrane Library, fourth quarter, 2004); bibliographies of retrieved publications; and additional information from 50 trials. Two reviewers independently selected parallel-group randomized and quasi-randomized, controlled trials of low-dose dopamine versus control. Study methods, clinical and renal physiologic outcomes, and adverse events (arrhythmias and myocardial, limb, and cutaneous ischemia) were extracted. 61 trials that randomly assigned 3359 patients were identified. Meta-analyses using random-effects models showed no effect of low-dose dopamine on mortality (relative risk, 0.96 [95% CI, 0.78 to 1.19]), need for renal replacement therapy (relative risk, 0.93 [CI, 0.76 to 1.15]), or adverse events (relative risk, 1.13 [CI, 0.90 to 1.41]). Low-dose dopamine increased urine output by 24% (CI, 14% to 35%) on day 1. Improvements in serum creatinine level (4% relative decrease [CI, 1% to 7%]) and measured creatinine clearance (6% relative increase [CI, 1% to 11%]) on day 1 were clinically insignificant. There were no significant changes on days 2 and 3 of therapy. Statistically significant between-study heterogeneity in physiologic but not clinical outcomes was unexplained by prespecified hypotheses. Low-dose dopamine offers transient improvements in renal physiology, but no good evidence shows that it offers important clinical benefits to patients with or at risk for acute renal failure.