Tijdschrift voor kindergeneeskunde

, Volume 70, Issue 4, pp 102–105 | Cite as

Dopamine in lage dosis in de neonatale en pediatrische intensive care: is er nog een indicatie?

  • I. Prins
  • F. B. Plötz
  • C. S. P. M. Uiterwaal
  • A. J. van Vught
Artikelen
  • 8 Downloads

Samenvatting

Dopamine is een endogeen catecholamine, een precursor van noradrenaline. Dopamine in lage dosis (ldd) (< 4µ/kg/min) wordt op intensive-care-afdelingen bij zowel volwassenen, zuigelingen en kinderen veelvuldig gebruikt vanwege het vermeende nierfunctiebeschermende effect. In dit overzichtsartikel wordt de fysiologie van dopamine en dopaminereceptoren van de nier besproken. Bij gezonde volwassenen geeft ldd toegenomen nierdoorbloeding met toename in diurese en natriurese. Bij ernstig zieke volwassenen is het gebruik van ldd controversieel, omdat tot op heden in grote gerandomiseerde trials geen toename is gevonden van de creatinineklaring of de glomerulaire filtratiesnelheid. Ook bij zieke zuigelingen en kinderen op de intensive care wordt ldd gebruikt, zoals blijkt uit een door ons gehouden enquête. Wij verrichtten literatuuronderzoek naar de renale effecten van ldd bij deze leeftijdsgroep en vonden slechts één gerandomiseerde studie, waarin geen statistisch significant effect werd gevonden op de nierfunctie of diurese. Alle andere studies waren niet gerandomiseerd en daaruit kon geen duidelijke conclusie getrokken worden. Mogelijk zijn er effecten van ldd, maar die zijn tot nu toe nog niet aangetoond. Het gebruik van ldd kan vooralsnog niet aangeraden worden, ook gezien de bijwerkingen, tot een gerandomiseerde placebo-gecontroleerde studie uitsluitsel geeft.

Summary

Dopamine is an endogenous catecholamine, an immediate precursor of noradrenaline. Low-dose dopamine (< 4 µ/kg/min)(ldd) has widely been used in intensive care for its supposed renal protective effects in adults, children and neonates as well. In this review we discuss the physiology of renal dopamine and dopamine receptors. In healthy adult volunteers ldd increases renal blood flow and sodium excretion and enhances urine volume. In critically ill adults the use of ldd remains controversial as unequivocal evidence of improvement in renal function, i.e. an increase in creatinine clearance or glomerular filtration rate, has not been published to date. ldd is also commonly used in neonatal and pediatric intensive care units for the same reasons. As indicated by the results of our survey of current use in the Netherlands, almost all units used ldd more or less regularly. We reviewed the literature in this age group, but we found only one randomised controlled trial, in which no statistically significant effect of ldd on renal function and urine volume is reported. All other studies were non-randomised and similarly inconclusive. In view of the adverse effects, the use of ldd in neonatal and paediatric patients should be reconsidered until a placebo-controlled trial yields new evidence.

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Literatuur

  1. Prins I, Plötz FB, Uiterwaal CSPM, Vught, HJ van. Low-dose dopamine in neonatal and pediatric intensive care: a systematic review. Intensive Care Med 2001;27:206-10.CrossRefPubMedGoogle Scholar
  2. Cheung P-Y, Barrington KJ. Renal dopamine receptors: mechanisms of action and developmental aspects. Cardiovasc Res 1996;31:2-6.PubMedGoogle Scholar
  3. Sulyok E, Seri I. Tulassay T, et al. The effects of dopamine administration on the activity of the renin-angiotensin-aldosterone system in sick preterm infants. Eur J Pediatr 1985;43:191-3.CrossRefGoogle Scholar
  4. McCrath BP, Bode K, Luxford A, et al. Effects of dopamine on renal function in the rat isolated perfused kidney. Clin Exp Pharmacol Physiol 1985;12:343-52.CrossRefGoogle Scholar
  5. Seri I, Aperia A. Contribution of dopamine2 receptors to the dopamine-induced increase in glomerular filtration rate. Am J Physiol 1988;254:F196-20.PubMedGoogle Scholar
  6. Seri I, Kone BC, Gullans SR, et al. Locally formed dopamine inhibits Na+,-K+-ATPase activity in rat renal cortical tubules cells. Am J Physiol 1988;255:F666-73.PubMedGoogle Scholar
  7. Seri I, Kone BC, Gullans SR, et al. Influence of Na+ intake on dopamine-induced inhibition of renal cortical Na+,-K+-ATPase. Am J Physiol 1990;285:F52-60.Google Scholar
  8. Seri I. Cardiovascular, renal, and endocrine actions of dopamine in neonates and children. J Pediatr 1995;126:333-44.CrossRefPubMedGoogle Scholar
  9. Huo T, Ye MQ, Healy DP. Characterization of a dopamine receptor (DA2k) in the kidney inner medulla. Proc Natl Acad Sci USA 1991;88:3170-4.CrossRefPubMedGoogle Scholar
  10. Girbes ARJ, Hoogenberg K. The use of dopamine and norepinephrine in the ICU. In: Vincent JL, ed. Yearbook of intensive care and emergency medicine. Berlin: Springer, 1998;178-87.Google Scholar
  11. José PA, Eisner GM, Felder RA. Renal dopamine receptors in health and hypertension. Pharmacol Ther 1998;80:149-82.CrossRefPubMedGoogle Scholar
  12. McDonald Jr RH, Goldberg LI, McNay JL, et al. Effects of dopamine in man: augmentation of sodium excretion, glomerular filtration rate and renal plasma flow. J Clin Invest 1964;43:1116-24.CrossRefPubMedGoogle Scholar
  13. Olsen NV, Hansen JM, Ladegoged SD, et al. Renal tubular reabsorption of sodium and water during infusion of low-dose dopamine in normal man. Clin Sci 1990;78:503-7.PubMedGoogle Scholar
  14. Goldberg LI. Cardiovascular and renal actions of dopamine: potential clinical applications. Pharmacol Rev 1972;24:1-29.PubMedGoogle Scholar
  15. Wang ZQ, Siragy HM, Felder RA, et al. Intrarenal dopamine production and distribution in the rat: physiological control of sodium excretion. Hypertension 1997;29:228-34.PubMedGoogle Scholar
  16. Hansell P, Fasching A. The effect of dopamine receptor blockade on natriuresis is dependent on the degree of hypervolemia. Kidney Int 1991;39:253-58.CrossRefPubMedGoogle Scholar
  17. Emilien G, Maloteaux J-M, Geurts M, et al. Dopamine receptors - physiological understanding to the therapeutic intervention potential. Pharmacol Ther 1999;84:133-56.CrossRefPubMedGoogle Scholar
  18. Australian and New Zealand Intensive Care Society (ANZICS) Clinical Trials Group. Low-dose dopamine in patients with early renal dysfunction: a placebo-controlled randomised trial. Lancet 2000;356:2139-43.Google Scholar
  19. Galley HF. Renal-dose dopamine: will the message now get through? Lancet 2000;356:2112-3.CrossRefPubMedGoogle Scholar
  20. Allen E, Pettigrew A, Frank D, et al. Alterations in dopamine clearance and catechol-O-methyltransferase activity by dopamine infusions in children. Crit Care Med 1997;25:181-9.CrossRefPubMedGoogle Scholar
  21. Justin RN, Moran L, Hooper J, et al. Dopamine clearance in critically ill patients. Intensive Care Med 1998;24:1217-20.CrossRefGoogle Scholar
  22. Hoogenberg K, Smit AJ, Girbes ARJ. Effects of low-dose dopamine on renal and systemic hemodynamics during incremental norepinephrine infusion in healthy volunteers. Crit Care Med 1998;26:260-5.CrossRefPubMedGoogle Scholar
  23. Nakamura KT, Felder RA, José PA, et al. Effects of dopamine in the renal vascular bed of fetal, newborn, and adult sheep. Am J Physiol 1987;252:R490-7.PubMedGoogle Scholar
  24. Pearson RJ, Jirsh DW, Barrington KJ, et al. Are DA1 dopamine receptors functional in newborn piglet mesenteric or renal vasculature? Surg Forum 1994;44:628-31.Google Scholar
  25. Tulassay T, Seri I, Machay T, et al. Effects of dopamine on renal functions in premature infants with respiratory distress syndrome. Int J Pediatr Nephrol 1983;4:19-23.PubMedGoogle Scholar
  26. Seri I, Tulassay T, Kiszel J, et al. Cardiovascular response in preterm infants with respiratory distress syndrome. Eur J Pediatr 1984;142:3-9.CrossRefPubMedGoogle Scholar
  27. Cuevas L, Yeh TF, John EG, et al. The effects of low-dose dopamine infusion on cardiopulmonary and renal status in premature newborns with respiratory distress syndrome. Am J Dis Child 1991;145:799-803.PubMedGoogle Scholar
  28. Girardin E, Berner M, Rouge JC, et al. Effect of low-dose dopamine on hemodynamics and renal function in children. Pediatr Res 1989;26:200-3.CrossRefPubMedGoogle Scholar
  29. Seri I, Abbasi S, Wood DC, Gerdes JS. Regional hemodynamic effects of dopamine in the sick preterm neonate. J Pediatr 1998;133:728-34.CrossRefPubMedGoogle Scholar
  30. Seri I, Rudas G, Bors ZS, et al. Effects of low-dose dopamine on cardiovascular and renal functions, cerebral blood flow, and plasma catecholamine levels in sick preterm neonates. Pediatr Res 1993;34:742-9.CrossRefPubMedGoogle Scholar

Copyright information

© Bohn Stafleu van Loghum 2002

Authors and Affiliations

  • I. Prins
    • 1
  • F. B. Plötz
  • C. S. P. M. Uiterwaal
  • A. J. van Vught
  1. 1.

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