CLINICAL STUDIES
The renal effect of low-dose dopamine in high-risk patients undergoing coronary angiography
Meir Gare, MD*,
Yosef S. Haviv, MD ,
Arie Ben-Yehuda, MD,
Dvorah Rubinger, MD ,
Tali Bdolah-Abram, MA*,
Shmuel Fuchs, MD*,
Ora Gat, BSc ,
Mordecai M. Popovtzer, MD,
Mervyn S. Gotsman, MD, FACC* and
Morris Mosseri, MD*
* Cardiology Department, Hadassah Hebrew University Medical Center, Jerusalem, Israel
Internal Medicine Division, Hadassah Hebrew University Medical Center, Jerusalem, Israel
Nephrology and Hypertension Services, Hadassah Hebrew University Medical Center, Jerusalem, Israel
Pharmacy Division, Hadassah Hebrew University Medical Center, Jerusalem, Israel
Manuscript received September 22, 1998;
revised manuscript received June 3, 1999,
accepted August 12, 1999.
Reprint requests and correspondence: Dr. Morris Mosseri, Cardiology Department, Hadassah University Hospital, Box 12000, Jerusalem, Israel 91120
mosseri{at}cc.huji.ac.il
OBJECTIVES
The purpose of the study was to examine the potential renal protective effect of low-dose dopamine in high-risk patients undergoing coronary angiography.
BACKGROUND
Contrast nephropathy is prevalent in patients with chronic renal failure (CRF) and/or diabetes mellitus (DM). Decreased renal blood flow due to vasoconstriction was suggested as a contributory mechanism. Low-dose dopamine has a dilatory effect on the renal vasculature.
METHODS
Sixty-six patients with mild or moderate CRF and/or DM undergoing coronary angiography were prospectively double-blindedly randomized, to either 120 ml/day of 0.9% saline plus dopamine 2 µg/kg/min (Dopamine group) or saline alone (Control group) for 48 h.
RESULTS
Thirty-three Dopamine-treated (30 diabetics and 6 with CRF) and 33 Control (28 diabetics and 5 with CRF) patients were compared. Plasma creatinine (Cr) level increased in the Control group from 100.6 ± 5.2 before to 112.3 ± 8.0 µmol/liter within five days after angiography (p = 0.003), and in the Dopamine group from 100.3 ± 5.4 before to 117.5 ± 8.8 µmol/liter after angiography (p = 0.0001), respectively. There was no significant difference in the change of Cr level ( Cr) between the two groups. However, in a subgroup of patients with peripheral vascular disease (PVD), Cr was –2.4 ± 2.3 in the Control group and 30.0 ± 12.0 µmol/liter in the Dopamine group (p = 0.01). No significant difference occurred in Cr between Control and Dopamine in subgroups of patients with preangiographic CRF or DM.
CONCLUSIONS
Contrast material caused a small but significant increase in Cr blood level in high-risk patients. There is no advantage of dopamine over adequate hydration in patients with mild to moderate renal failure or DM undergoing coronary angiography. Dopamine should be avoided in patients with PVD exposed to contrast medium.
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Abbreviations and Acronyms
| | CABG | = coronary artery bypass grafting | | Cr | = creatinine | | CRF | = chronic renal failure | | DM | = diabetes mellitus | | PVD | = peripheral vascular disease | | | = the difference between preangiographic and postangiographic value |
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