Renal effects of norepinephrine used to treat septic shock patients

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Abstract
Twenty-four patients with septic shock (cardiac index [CI] >4 L·min-1·m-2, systemic vascular resistance index [SVRI] ≤350 dyne·sec·cm-5·m-2, systolic BP >90 mm Hg, oliguria ≤ 30 ml/h) were treated with norepinephrine (NE) infused either alone or in combination with dopamine and/or dobutamine. In all patients, NE resulted in either an increase in BP, no change, or an increase in CI and restored SVRI to the normal range. In 20 patients, normalization of systemic hemodynamics was followed by re-establishment of urine flow, decrease in serum creatinine, and increase in creatinine clearance. None of these 20 patients received low dose dopamine or furosemide. Four patients remained oliguric. Two of these four patients died and two developed acute renal failure. These findings suggest that NE infusion does not worsen renal ischemia related to hemodynamic disturbances in septic shock patients, and may have beneficial effects on renal function.