Dopexamine use as prophylaxis for renal impairment in critically ill patients
Date First Published:
November 24, 2004
Last Updated:
June 3, 2010
Report by:
Melvin Carew, CT2 ACCS (Luton and Dunstable Intensive care)
Search checked by:
Muniswamy Hemavathi , Luton and Dunstable Intensive care
Three-Part Question:
In [critically ill non elective surgery adults] is [dopexamine] an [effective means to prevent renal failure]
Clinical Scenario:
A 62 year old, has been admitted to the intensive care unit following an emergency Hartmann’s procedure for a perforated diverticulum. He is clearly septic, with persistent pyrexia, hypotension, tachycardia and is being ventilated. He has been started on the sepsis bundle, including noradrenaline to maintain a decent MAP. He has a past medical history of treated hypertension, hypercholesterolaemia, and diverticullar disease.
It is clear that low dose dopamine has no renal protective effects but, you discuss the use of dopexamine on the ward round as an alternative. No one clear about the evidence for and against so you investigate.
It is clear that low dose dopamine has no renal protective effects but, you discuss the use of dopexamine on the ward round as an alternative. No one clear about the evidence for and against so you investigate.
Search Strategy:
Medline 1966-current
[Dopexamine.af] and [Renal failure.af] and [critical care.af] or [intensive care.af]
Limited to human and English language
[Dopexamine.af] and [Renal failure.af] and [critical care.af] or [intensive care.af]
Limited to human and English language
Outcome:
54 papers were found using the above search criteria, after exclusion of papers that were not relevant, 10 abstracts were reviewed three of which are presented in table 1.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Effect of dopexamine on outcome after major abdominal surgery: a prospective, randomized, controlled multicenter study. European Multicenter Study Group on Dopexamine in Major Abdominal Takala J, Meier-Hellmann A, Eddleston J, Hulstaert P, Sramek V. 2000 Six European countries | 433 patients defined as being high risk were randomised to placebo (144), 0.5µg/kg/min (143), 2.0µ/kg/min (145) <br><br>Treatment was started after stabilisation with fluids, blood products and oxygen as appropriate |
Prospective randomised control double blind multi-centre trial | Post-operative mortality and morbidity | No Benefit | A high proportion of patients in the study were high risk only because they were having planned extensive, ablative surgery for carcinoma or prolonged surgery >8hrs. This accounts for 78.3% |
| Renal dysfunction | No Benefit | ||||
| A randomised controlled trial investigating the effects of dopexamine on gastrointestinal function and organ dysfunction in the critically ill Ralph CJ, Tanser SJ, Macnaughton PD, Sinclair DG 2002 UK | 102 critically ill patients in two adult intensive care units.<br><br>52-treatment group<br><br>50-control<br><br>Dopexamine started at 0.5µg/kg/min and increased every 30mins<br><br>Treatment started after resuscitation | Prospective randomised control trial | Creatinine clearance | No Benefit | Method used to randomise patient not discussed |
| Organ dysfunction | No Benefit | ||||
| Gastrointestinal absorption | No Benefit | ||||
| Comparison of systemic and renal effects of dopexamine and dopamine in norepinephrine-treated septic shock. Schmoelz M, Schelling G, Dunker M, Irlbeck M 2006 Germany | 61 with defined septic shock over a 3-year period were identified<br><br>20-dopexamine group<br><br>20-placebo group<br><br>21-dopamine group<br><br>2µg/kg/min-dopexamine<br><br>3µg/kg/min-dopamine |
A prospective, randomized, controlled, double-blinded study | Renal function parameters | No Benefit | A major limitation is the small sample size |
| Organ failure scores | No Benefit |
Author Commentary:
All the studies showed no beneficial effects on the preservation of renal function with dopexamine regardless of the dose used.
A disadvantaged all the papers had, was the relatively small sample sizes, so a Type I error may still be present for smaller effects on renal and organ dysfunction. This highlights the need as emphasized in all the papers for larger study sample trials to detect smaller benefits
A disadvantaged all the papers had, was the relatively small sample sizes, so a Type I error may still be present for smaller effects on renal and organ dysfunction. This highlights the need as emphasized in all the papers for larger study sample trials to detect smaller benefits
Bottom Line:
There is currently no evidence to support the use of dopexamine in critically ill patients to prevent acute renal failure
References:
- Takala J, Meier-Hellmann A, Eddleston J, Hulstaert P, Sramek V. . Effect of dopexamine on outcome after major abdominal surgery: a prospective, randomized, controlled multicenter study. European Multicenter Study Group on Dopexamine in Major Abdominal
- Ralph CJ, Tanser SJ, Macnaughton PD, Sinclair DG. A randomised controlled trial investigating the effects of dopexamine on gastrointestinal function and organ dysfunction in the critically ill
- Schmoelz M, Schelling G, Dunker M, Irlbeck M. Comparison of systemic and renal effects of dopexamine and dopamine in norepinephrine-treated septic shock.