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Impact of dopamine infusion on renal function in hospitalized heart failure patients: results of the Dopamine in Acute Decompensated Heart Failure (DAD-HF) Trial.

Author(s): Giamouzis G, Butler J, Starling RC, Karayannis G, Nastas J, Parisis C, Rovithis D, Economou D, Savvatis K, Kirlidis T, Tsaknakis T, Skoularigis J, Westermann D, Tschope C, Triposkiadis F

Affiliation(s): Department of Cardiology, Larissa University Hospital, Larissa, Greece.

Publication date & source: 2010-12, J Card Fail., 16(12):922-30.

Publication type: Comparative Study; Randomized Controlled Trial

BACKGROUND: Worsening renal function (WRF) and hypokalemia related to diuretic use for acute decompensated heart failure (ADHF) are common and associated with poor prognosis. Low-dose dopamine infusion improves renal perfusion; its effect on diuresis or renal function specifically in ADHF is not known. METHODS AND RESULTS: Sixty consecutive ADHF patients (age 75.7 +/- 11.2 years; 51.7% female; left ventricular ejection fraction 35.3 +/- 12.1%) were randomized, after receiving a 40 mg intravenous furosemide bolus, to either high-dose furosemide (HDF, 20 mg/h continuous infusion for 8 hours) or low-dose furosemide combined with low-dose dopamine (LDFD, furosemide 5 mg/h plus dopamine 5 mug kg(-1) min(-1) continuous infusion for 8 hours). Both strategies were compared for total diuresis, WRF (defined as a rise in serum creatinine of >0.3 mg/dL from baseline to 24 hours), electrolyte balance, and 60-day postdischarge outcomes. Mean hourly excreted urine volume (272 +/- 149 mL in HDF vs 278 +/- 186 mL in LDFD group; P = .965) and changes in dyspnea score (Borg index: -4.4 +/- 2.1 in HDF group vs -4.7 +/- 2.0 in LDFD group; P = .575) during the 8 hours of protocol treatment were similar in the two groups. WRF was more frequent in the HDF (n = 9; 30%) than in the LDFD group (n = 2; 6.7%; P = .042). Serum potassium changed from 4.3 +/- 0.5 to 3.9 +/- 0.4 mEq/L at 24 hours (P = .003) in the HDF group and from 4.4 +/- 0.5 to 4.2 +/- 0.5 mEq/L at 24 hours (P = .07) in the LDFD group. Length of stay and 60-day mortality or rehospitalization rates (all-cause, cardiovascular, and worsening HF) were similar in the two groups. CONCLUSIONS: In ADHF patients, the combination of low-dose furosemide and low-dose dopamine is equally effective as high-dose furosemide but associated with improved renal function profile and potassium homeostasis. Copyright (c) 2010 Elsevier Inc. All rights reserved.

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