Skip to main content
SpringerLink
Log in

Renal effects of low-dose dopamine in patients with sepsis syndrome or septic shock treated with catecholamines

  • Original
  • Published:
Intensive Care Medicine Aims and scope Submit manuscript

Abstract

Objective

To evaluate the renal effects of low-dose dopamine in patients with sepsis syndrome or septic shock treated with catecholamines.

Design

Prospective, clinical study using sequential periods.

Setting

A 12-bed surgical intensive care unit in a university hospital.

Patients

14 patients with sepsis syndrome and 15 patients with septic shock treated with exogenous catecholamines were studied. They had no diuretic treatment.

Intervention

Two periods of 2 h each with and without 2μg·kg−1·min−1 of dopamine infusion. Hemodynamic and renal data were obtained at the end of each period. Measurements were repeated after 48 h of dopamine infusion in patients with sepsis syndrome. All data were evaluated by the Wilcoxon rank test.

Measurements and results

In patients with sepsis syndrome, diuresis and creatinine clearance increased significantly by 100% and 60%, respectively, during low-dose dopamine infusion without any change in systemic hemodynamics. The renal response to dopamine decreased significantly after 48 h of dopamine infusion (P<0.01). In patients with septic shock treated with catecholamines, no variation of either systemic hemodynamics or renal function was noted during low-dose dopamine infusion.

Conclusion

The renal effects of low-dose dopamine in patients with sepsis syndrome decrease with time. No renal effect of low-dose dopamine was observed in patients with septic shock treated with catecholamines. These findings suggest a desensitization of renal dopaminergic receptors.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Hebert PC, Drummond AJ, Singezr J, Bernard GR, Russell JA (1993) A simple multiple system organ failure scoring system predicts mortality of patients who have sepsis syndrome. Chest 104: 230–235

    Google Scholar 

  2. Lowell JA, Schifferdecker C, Driscoll DF, Benotti PN, Bistrian BR (1990) Postoperative fluid overload: not a benign problem. Crit Care Med 18: 728–733

    Google Scholar 

  3. Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) Prognosis in acute organ system failure. Ann Surg 202: 685–693

    Google Scholar 

  4. Regnier B, Rapin M, Gory G, Lemaire F, Teisseire B, Harari A (1977) Haemodynamic effects of dopamine in septic shock. Intensive Care Med 3: 47–53

    Google Scholar 

  5. Duke GJ, Bersten AD (1992) Dopamine and renal salvage in the critically ill patient. Anaesth Intensive Care 20: 277–302

    Google Scholar 

  6. Goldberg LI, McDonald RH, Zimmerman AM (1983) Sodium diuresis produced by dopamine in patients with congestive heart failure. N Engl J Med 14: 1060–164

    Google Scholar 

  7. McDonald RH, Goldberg LI, McNay JL, Tuttle EP (1964) Effects of dopamine in man: augmentation of sodium excretion, glomerular filtration rate and renal plasma flow. J Clin Invest 43: 1116–1124

    Google Scholar 

  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 Biochim 2: 511–520

    Google Scholar 

  9. Parker S, Carlon G, Isaacs M, Howland WS, Kahn RC (1981) Dopamine administration in oliguria and oliguric renal failure. Crit Care Med 9: 630–632

    Google Scholar 

  10. Szerlip HM (1991) Renal dose dopmine:fact and fiction. Ann Intern Med 115: 153–154

    Google Scholar 

  11. Schaer GL, Fink MP, Parillo JE (1985) Norepinephrine alone versus norepinephrine plus low-dose dopamine: enhanced renal blood flow with combination pressor therapy. Crit Care Med 13: 492–496

    Google Scholar 

  12. Fink MP, Nelson R, Roethel R (1985) Low-dose dopamine preserves renal blood flow in endotoxin shocked dogs treated with ibuprofeh. J Surg Res 38: 582–591

    Google Scholar 

  13. Orme ML, Breckenridge A, Dollery CT (1973) The effects of long term administration of dopamine on renal function in hypertensive patients. Eur J Clin Pharmacol 6: 150–155

    Google Scholar 

  14. Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, Schein RM, Sibbald WJ (1992) Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Comittee. Chest 101: 1644–1655

    Google Scholar 

  15. Lindner A (1983) Synergism of dopamine and furosemide in diuretic-resistant oliguric acute renal failure. Nephron 33: 121–126

    Google Scholar 

  16. Le Gall JR and the French multicenter group of ICU research (1989) Factors related to outcome in intensive care: French multicenter study. Crit Care Med 17: 305–308

    Google Scholar 

  17. Elebute EA, Stoner HB (1983) The grading of sepsis. Br J Surg 70: 29–32

    Google Scholar 

  18. Le Corre P, Malledant Y, Tanguy M, Le Verge R (1993) Steady state pharmacokinetics of dopamine in adult patients. Crit Care Med 21: 1652–1657

    Google Scholar 

  19. Wilson RF, Soullier G (1980) The validity of two-hour creatinine clearance studies in critically ill patients. Crit Care Med 8: 281–283

    Google Scholar 

  20. Sladen RN, Endo E, Harrison T (1987) Two-hour versus 22 h creatinine clearance in critically ill patients. Anesthesiology 67: 1013–1016

    Google Scholar 

  21. Schwartz D, Lazar P, Papoz L (1985) Statistiques médicales et biologiques. In: Schwartz D (ed) Flammarion pp 95 117, pp 277–284

  22. Martin C, Eon B, Saux P, Aknin P, Gouin F (1990) Renal effects of norepinephrine used to treat septic shock patients. Crit Care Med 18: 282–285

    Google Scholar 

  23. Martin C, Papazian L, Perrin G, Saux P, Gouin F (1993) Norepinephrine or dopamine for the treatment of hyperdynamic septic shock? Chest 103: 1826–1831

    Google Scholar 

  24. Flancbaum L, Choban PS, Dasta JF (1994) Quatitative effects of low dose dopamine on urine output in oliguric surgical intensive care unit patients. Crit Care Med 22: 61–66

    Google Scholar 

  25. Tamaki T, Hura CE, Kunau RT (1989) Dopamine stimulates cAMP production in canine afferent arterioles via DA1 receptors. Am J Physiol 256: 626–629

    Google Scholar 

  26. Seri I, Kone BC, Gullans SR et al. (1988) Locally formed dopamine inhibits Na+-K+-ATPase activity in rat cartical tubule cells. Am J Physiol 255: F666–673

    Google Scholar 

  27. Felder RA, Blecher M, Calcagno PL, et al (1984) Dopamine receptors in the proximal tubule of the rabbit. Am J Physiol 247: 499–505

    Google Scholar 

  28. Waelbroek M, Taton G, Delhaye M, Chatelain P, Camus JC, Pochet R, Leclerc JL, Desmet JM, Robberecht P, Christophe J (1983) The human heart beta-adrenergic receptors: coupling of beta 2-adrenergic receptors with the adenylate cyclase system. Mol Pharmacol 24: 174–182

    Google Scholar 

  29. Bristow MR, Ginsburg R, Minobe W, Cubiccioti RS, Scott Sageman W, Keith Lurie MS, Billingham ME, Harrison DC, Stinson EB (1982) Decreased catecholamine sensitivity and betaadrenergic receptor density in failing human hearts. N Engl J Med 307: 205–211

    Google Scholar 

  30. Tashkin DP, Conolly ME, Deutsch RI, Hui KK, Littner M, Scarpace P, Abrass I (1982) Subsensitization of betaadrenoceptors in airways and lymphocytes of healthy and asthmatic subjects. Am Rev Respir Dis 125: 185–193

    Google Scholar 

  31. Bristow MR, Laser JA, Minobe W, Ginsburg R, Fowler MB, Rasmussen R (1984) Selective down-regulation of beta 1 adrenergic receptors in the failing human heart. Circulation 70: 61–67

    Google Scholar 

  32. Strigle TR, Petrinec D (1990) The effect of renal range dopamine and norepinephrine infusions on the renal vasculature. Am Surg 56: 494–496

    Google Scholar 

  33. Sibley DR, Lefkowitz RJ (1985) Molecular mechanism of receptor desensitization using beta adrenergic receptor coupled adenylate cyclase system as a model. Nature 317: 124–129

    Google Scholar 

  34. Schwinn DA (1993) Adrenoceptors as model for G protein-coupled receptors: structure, function and regulation. Br J Anaesth 71: 77–85

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Departement d'Anesthésie-Réanimation, Hopital Antoine Béclère, Université Paris-Sud, 157 rue de la Porte de Trivaux, F-92141, Clamart Cedex, France

    T. Lherm, G. Troché, M. Rossignol & J. F. Zazzo

  2. Département de Biochimie Hôpital Antoine Béclère, Université Paris-Sud, Clamart Cedex, France

    P. Bordes

Authors
  1. T. Lherm
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. G. Troché
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Rossignol
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. P. Bordes
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. J. F. Zazzo
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lherm, T., Troché, G., Rossignol, M. et al. Renal effects of low-dose dopamine in patients with sepsis syndrome or septic shock treated with catecholamines. Intensive Care Med 22, 213–219 (1996). https://doi.org/10.1007/BF01712239

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01712239

Key words

Search

Navigation