Use of Dopaminergic Agonists for Renal Protection in the ICU

  • P. T. Murray
Conference paper


The mortality of acute renal failure is commonly 50–80% in the intensive care unit (ICU), and has not declined significantly since the initial marked benefit of acute dialysis therapy, despite numerous advances in renal replacement technologies and critical care over several decades. Most acute renal failure in ICU patients is caused by either prerenal azotemia (reversible renal insufficiency due to renal hypoperfusion) or acute tubular necrosis (ATN). ATN results from a variety of ischemic and nephrotoxic insults, often in additive or synergistic combination. Because renal hypoperfusion plays a role in the pathogenesis of prerenal azotemia and ATN, ‘lowdose’ dopamine dopamine is commonly used as a renal vasodilator aiming to prevent or treat acute renal failure in the ICU. This chapter reviews the use of dopamine and a novel dopaminergic agonist called fenoldopam for renal protection in the ICU.


Intensive Care Unit Acute Renal Failure Intensive Care Unit Patient Renal Blood Flow Acute Tubular Necrosis 
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  1. 1.
    Murray PT (1999) Pathogenesis and management of septic shock. Seminars in Anesthesia, Perioperative Medicine, and Pain: 18: 192–203CrossRefGoogle Scholar
  2. 2.
    Murray PT, Wylam ME, Umans JG (2000) Nitric oxide and septic vascular dysfunction. Anesth Analg 90: 89–101PubMedCrossRefGoogle Scholar
  3. 3.
    Duke GJ, Briedis JH, Weaver RA (1994) Renal support in critically ill patients: low-dose dopamine or low-dose dobutamine. Grit Care Med 22: 1919–1925Google Scholar
  4. 4.
    Bersten AD, Holt AW (1995) Vasoactive drugs and the importance of renal perfusion pressure. New Horiz 3: 650–661PubMedGoogle Scholar
  5. 5.
    Kelleher SP, Robinette JB, Conger JD (1984) Sympathetic nervous system in the loss of autoregulation in acute renal failure. Am J Physiol 246: F379 - F386PubMedGoogle Scholar
  6. 6.
    Zager RA (1992) Endotoxemia, renal hypoperfusion, and fever: interactive risk factors for aminoglycoside and sepsis-induced acute renal failure. Am J Kidney Dis 20: 223–230PubMedGoogle Scholar
  7. 7.
    Neveu H, Kleinknecht D, Brivet F, Loirat P, Landais P (1996) Prognostic factors in acute renal failure due to sepsis. Results of a prospective multicentre study. Nephrol Dial Transplant 11: 293–299Google Scholar
  8. 8.
    D’Orio V, El Allaf D, Juchmes J, Marcelle R (1984) The use of low doses of dopamine in intensive care medicine. Arch Int Physiol Biochem 92: 511 - S20Google Scholar
  9. 9.
    Olson D, Pohlman A, Hall JB (1996) Administration of low-dose dopamine to nonoliguric patients with sepsis syndrome does not raise intramural gastric pH nor improve creatinine clearance. Am J Respir Crit Care Med 154: 1664–1670PubMedCrossRefGoogle Scholar
  10. 10.
    Lherm T, Troche G, Rossignol M, Bordes P, Zazzo JF (1996) Renal effects of low-dose dopamine in patients with sepsis syndrome or septic shock treated with catecholamines. Intensive Care Med 22: 213–219PubMedCrossRefGoogle Scholar
  11. 11.
    Juste RN, Panikkar K, Soni N (1998) The effects of low-dose dopamine infusions on hemodynamic and renal parameters in patients with septic shock requiring treatment with nor-adrenaline. Intensive Care Med 24: 564–568PubMedCrossRefGoogle Scholar
  12. 12.
    Schaer GL, Fink MP, Parrillo JE (1985) Norepinephrine alone versus norepinephrine plus low-dose dopamine: enhanced renal blood flow with combination pressor therapy. Crit Care Med 13: 492–496PubMedCrossRefGoogle Scholar
  13. 13.
    Richer M, Robert S, Lebel M (1996) Renal hemodynamics during norepinephrine and low-dose dopamine infusions in man. Crit Care Med 24: 1150–1156PubMedCrossRefGoogle Scholar
  14. 14.
    Hoogenberg K, Smit AJ, Girbes ARJ (1998) Effects of low-dose dopamine on renal and systemic hemodynamics during incremental norepinephrine infusion in healthy volunteers. Crit Care Med 26: 260–265PubMedCrossRefGoogle Scholar
  15. 15.
    Benmalek E, Behforouz N, Benoist J-F, et al (1999) Renal effects of low-dose dopamine during vasopressor therapy for posttraumatic intracranial hypertension. Intensive Care Med 25: 399–405PubMedCrossRefGoogle Scholar
  16. 16.
    Denton MD, Chertow GM, Brady HR (1996) Renal-dose dopamine for the treatment of acute renal failure: Scientific rationale, experimental studies and clinical trials. Kidney Int 49: 4–14Google Scholar
  17. 17.
    Kellum JA, Decker JM (2001) Use of dopamine in acute renal failure: A meta-analysis. Crit Care Med 29: 1526–1531Google Scholar
  18. 18.
    Marik PE (2002) Low-dose dopamine: a systematic review. Intensive Care Med 28: 877–883PubMedCrossRefGoogle Scholar
  19. 19.
    Schnuelle P, Lorenz D, Mueller A, et al (1999) Donor catecholamine use reduces the allo-graft rejection and improves survival after cadaveric renal transplantation. Kidney Int 56: 738–746PubMedCrossRefGoogle Scholar
  20. 20.
    ANZICS Clinical Trials Group (2000) Low-dose dopamine in patients with early renal dysfunction: a placebo-controlled randomised trial. Lancet 356: 2139–243CrossRefGoogle Scholar
  21. 21.
    Neviere R, Mathieu D, Chagnon J-L, et al (1996) The contrasting effects of dobutamine and dopamine on gastric mucosal perfusion in septic patients. Am J Respir Crit Care Med 154: 1684–1688PubMedCrossRefGoogle Scholar
  22. 22.
    Segal JM, Phang PT, Walley KR (1992) Low-dose dopamine hastens onset of gut ischemia in a porcine model of hemorrhagic shock. J Appl Physiol 73: 1159–1164PubMedGoogle Scholar
  23. 23.
    Chiolero R, Borgeat A, Fisher A (1991) Postoperative arrhythmias and risk factors after open heart surgery. Thorac Cardiovasc Surg 39: 81–84PubMedCrossRefGoogle Scholar
  24. 24.
    Van den Berghe G, de Zegher F (1996) Anterior pituitary function during critical illness and dopamine treatment. Crit Care Med 24: 1580–1590PubMedCrossRefGoogle Scholar
  25. 25.
    Devins SS, Miller A, Herndon BL, et al (1992) Effects of dopamine on T-lymphocyte proliferative responses and serum prolactin concentrations in critically ill patients Crit Care Med 20: 1644–1649Google Scholar
  26. 26.
    Juste RN, Moran L, Hooper J, Soni N (1998) Dopamine clearance in critically ill patients. Intensive Care Med 24: 1217–1220PubMedCrossRefGoogle Scholar
  27. 27.
    Chertow GM, Sayegh MH, Allgren RL, Lazarus, JM (1996) Is the administration of dopamine associated with adverse or favorable outcomes in acute renal failure? Auriculin Anaritide Acute Renal Failure Study Group. Am J Med 101: 49–53PubMedCrossRefGoogle Scholar
  28. 28.
    Abizaid AS, Clark CE, Mintz GS, et al (1999) Effects of dopamine and aminophylline on contrast-induced acute renal failure after coronary angioplasty in patients with preexisting renal insufficiency. Am J Cardiol 83: 260–263PubMedCrossRefGoogle Scholar
  29. 29.
    Neiberger RE, Passmore JC (1979) Effects of dopamine on canine intrarenal blood flow distribution during hemorrhage. Kidney Int 15: 219–226PubMedCrossRefGoogle Scholar
  30. 30.
    Murphy MB, Murray C, Shorten GD (2001) Fenoldopam–a selective peripheral dopamine-receptor agonist for the treatment of severe hypertension. N Engl J Med 345: 1548–1556PubMedCrossRefGoogle Scholar
  31. 31.
    Bodner A, Murray P (2000) Fenoldopam: A Dopaminergic Vasodilator. Current Concepts in Hypertension 4: 5–6Google Scholar
  32. 32.
    Brogden RN, Markham A (1997) Fenoldopam. A review of its pharmacodynamic and pharmacokinetic properties and intravenous clinical potential in the management of hypertensive urgencies and emergencies. Drugs 54: 634–650Google Scholar
  33. 33.
    Singer I, Epstein M (1998) Potential of dopamine A-1 agonists in the management of acute renal failure. Am J Kidney Dis 31: 743–755PubMedCrossRefGoogle Scholar
  34. 34.
    Elliott WJ, Weber RR, Nelson KS, et al (1990) Renal and hemodynamic effects of intravenous fenoldopam versus nitroprusside in severe hypertension. Circulation 81: 970–977PubMedCrossRefGoogle Scholar
  35. 35.
    Shusterman NH, Elliott WJ, White WB (1993) Fenoldopam, but not nitroprusside, improves renal function in severely hypertensive patients with impaired renal function. Am J Med 95: 161–168PubMedCrossRefGoogle Scholar
  36. 36.
    Aronson S, Goldberg LI, Roth S, et al (1990) Preservation of renal blood flow during hypotension induced with fenoldopam in dogs. Can J Anesth 37: 380–384PubMedCrossRefGoogle Scholar
  37. 37.
    Aronson S, Goldberg LI, Roth S, et al (1991) Effects of fenoldopam on renal blood flow and systemic hemodynamics during isoflurane anesthesia. J Cardiothorac Vasc Anesth 5: 29–32PubMedCrossRefGoogle Scholar
  38. 38.
    Kien ND, Moore PG, Jaffe RS (1992) Cardiovascular function during induced hypotension by fenoldopam or sodium nitroprusside in anesthetized dogs. Anesth Analg 74: 74–82CrossRefGoogle Scholar
  39. 39.
    Mathur VS, Swan SK, Lambrecht LJ, et al (1999) The effects of fenoldopam, a selective dopamine receptor agonist, on systemic and renal hemodynamics in normotensive subjects. Crit Care Med 27: 1832–1837PubMedCrossRefGoogle Scholar
  40. 40.
    Allison NL, Dubb JW, Ziemniak JA, et al (1987) The effect of fenoldopam, a dopaminergic agonist, on renal hemodynamics. Clin Pharmacol Therap 41: 282–288CrossRefGoogle Scholar
  41. 41.
    Poinsot O, Romand JA, Favre H, Suter PM (1993) Fenoldopam improves renal hemodynamics impaired by positive pressure. Anesthesiology 79: 680–684PubMedCrossRefGoogle Scholar
  42. 42.
    Schuster HP, Suter PM, Hemmer M, et al (1991) Fenoldopam improves renal dysfunction secondary to ventilation with PEEP. Intensivmedizin 28: 348–355Google Scholar
  43. 43.
    Jorkasky DK, Audet P, Shusterman N, et al (1992) Fenoldopam reverses cyclosporine-induced renal vasoconstriction in kidney transplant recipients. Am J Kidney Dis 19: 567–572PubMedGoogle Scholar
  44. 44.
    Bakris GL, Lass NA, Glock D (1999) Renal hemodynamics in radiocontrast medium-induced renal dysfunction: a role for dopamine-1 receptors. Kidney Int 56: 206–210PubMedCrossRefGoogle Scholar
  45. 45.
    Siragy HM, Felder RA, Howell NL, et al (1990) Evidence that dopamine-2 mechanisms control renal function. Am J Physiol 259: F793 - F800PubMedGoogle Scholar
  46. 46.
    Carey RM, Siragy HM, Ragsdale NV, et al (1990) Dopamine-1 and Dopamine-2 mechanisms in the control of renal function. Am J Hypertens 3: 59S - 63SPubMedGoogle Scholar
  47. 47.
    Germann R, Hasibeder W, Haisjackl M, et al (1995) Dopamine-l-receptor stimulation and mucosal tissue oxygenation in the porcine jejunum. Crit Care Med 23: 1560–1566PubMedCrossRefGoogle Scholar
  48. 48.
    Vlavianos P, Poison RJ, Settin A, et al (1990) Haemodynamic and pharmacokinetic study of intravenous fenoldopam in patients with hepatic cirrhosis. Br J Clin Pharmacol 29: 19–25PubMedCrossRefGoogle Scholar
  49. 49.
    Hadengue A, Moreau R, Bacq Y, et al (1991) Selective dopamine DA1 stimulation with fenoldopam in cirrhotic patients with ascites: a systemic, splanchnic, and renal hemodynamic study. Hepatology 13: 111–116PubMedCrossRefGoogle Scholar
  50. 50.
    Patel JJ, Mitha AS, Sareli P, de Vaal JB (1993) Intravenous fenoldopam infusion in severe heart failure. Cardiovasc Drugs Ther 7: 97–101PubMedCrossRefGoogle Scholar
  51. 51.
    Barnard ML, Ridge KM, Saldias F, et al (1999) Stimulation of the dopamine 1 receptor increases lung edema clearance. Am J Respir Crit Care Med 160: 982–986PubMedCrossRefGoogle Scholar
  52. 52.
    Heyman SN, Brezis M, Epstein FH, et al (1991) Early renal medullary hypoxic injury from radiocontrast and indomethacin. Kidney Int 40: 632 - -642PubMedCrossRefGoogle Scholar
  53. 53.
    Weisberg LS, Kurnik PB Kurnik BR (1992) Radiocontrast-induced nephropathy in humans: role of renal vasoconstriction. Kidney Int 41: 1408–1415PubMedCrossRefGoogle Scholar
  54. 54.
    Liss P, Nygren A, Erikson, U, Ulfendahl HR (1998) Injection of low and iso-osmolar contrast medium decreases oxygen tension in the renal medulla. Kidney Int 53: 698–702PubMedCrossRefGoogle Scholar
  55. 55.
    Tumlin JA, Wang A, Murray PT, Mathur VS (2002) Fenoldopam mesylate blocks reductions in renal plasma flow after radiocontrast dye infusion: A pilot trial in the prevention of contrast nephropathy. Am Heart J 143: 894–903Google Scholar
  56. 56.
    Stone GW, Tumlin JA, Madyoon H, et al (2001) Design and rationale of CONTRAST - a prospective, randomized placebo-controlled trial of fenoldopam mesylate for the prevention of radiocontrast nephropathy. Rev Cardiovasc Med 2 (Suppl 1): S31 - S35PubMedGoogle Scholar
  57. 57.
    Halpenny M, Markos F, Snow HM, et al (2000) The effects of fenoldopam on renal blood flow and tubular function during aortic cross-clamping in anaesthetized dogs. Eur J Anaesthesiol 17: 491–498PubMedGoogle Scholar
  58. 58.
    Halpenny M, Lakshmi S, O’Donnell A, et al (2001) Fenoldopam: renal and splanchnic effects in patients undergoing coronary artery bypass grafting. Anaesthesia 56: 953–960PubMedCrossRefGoogle Scholar
  59. 59.
    Halpenny M, Rushe C, Breen P, et al (2002) The effects of fenoldopam on renal function in patients undergoing elective aortic surgery. Eur J Anaesthesiol 19: 32–39PubMedGoogle Scholar
  60. 60.
    Halpenny M, Markos F, Snow HM, et al (2001) Effects of prophylactic fenoldopam infusion on renal blood flow and renal tubular function during acute hypovolemia in anesthetized dogs. Crit Care Med 29: 855–860PubMedCrossRefGoogle Scholar

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© Springer-Verlag Berlin Heidelberg 2003

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  • P. T. Murray

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