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| 2007 JASN IMPACT FACTOR 7.111 | HOME AUTHOR INFO EDITORIAL BOARD SUBSCRIBE FEEDBACK ALERTS HELP | |||
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| 2007 JASN IMPACT FACTOR 7.111 | HOME AUTHOR INFO EDITORIAL BOARD SUBSCRIBE FEEDBACK ALERTS HELP | |||
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*
Department of Cardiothoracic and Vascular Anesthesia and Intensive Care,
Division of Nephrology, University Clinic of Vienna, Austria.
Department of Internal Medicine I, Division of Nephrology, University
Clinic of Vienna, Austria.
Department of Internal Medicine III, Division of Nephrology, University
Clinic of Vienna, Austria.
Correspondence to Dr. Michael Hiesmayr, University Clinic of Anesthesia (HTG), Währinger Gürtel 18-20, A-1090 Vienna, Austria. Phone: +43 1 40400 4109; Fax: +43 1 40400 6404; E-mail: michael.hiesmayr{at}akh-wien.ac.at
Abstract. 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 µg/kg per min) (group D), furosemide
(0.5 µg/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 (
Creamax) 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
Creamax >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, renal-dose dopamine is
ineffective and furosemide is even detrimental in the protection of renal
dysfunction after cardiac surgery.
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Copyright © 2008 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673
