Elsevier

Journal of Cardiac Failure

Volume 16, Issue 12, December 2010, Pages 922-930
Journal of Cardiac Failure

Clinical Trial
Impact of Dopamine Infusion on Renal Function in Hospitalized Heart Failure Patients: Results of the Dopamine in Acute Decompensated Heart Failure (DAD-HF) Trial

https://doi.org/10.1016/j.cardfail.2010.07.246Get rights and content

Abstract

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 μg 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.

Clinical Trial Registration Information

ClinicalTrials.gov Identifier: NCT00937092 (http://clinicaltrials.gov/ct2/show/NCT00937092)

Section snippets

Setting

The Dopamine in Acute Decompensated Heart Failure (DAD-HF) trial was a randomized double-blind study including patients hospitalized with ADHF in two Greek centers: a tertiary academic medical center (Larissa University Hospital, Larissa, Greece) and a general hospital (General Hospital of Volos, Volos, Greece).

Patient Population

ADHF patients with New York Heart Association (NYHA) functional class IV symptoms admitted between January 2009 and December 2009 were included in this study. Inclusion in the study

Baseline Patient Characteristics

The baseline characteristics of the study population are presented in Table 1. Admission systolic blood pressure was higher in the HDF than in the LDFD group (176 ± 33 vs. 157 ± 28 mm Hg; P = .031). No other significant differences between the two groups regarding demographics, clinical/hemodynamic variables, coexisting morbidities, and medications were observed.

Treatment Effects

During the 8 hours of protocol treatment, systolic, diastolic, and mean blood pressure as well as heart rate decreased significantly

Discussion

The results of this study show that the combination of low-dose furosemide and low-dose dopamine infusion is as effective as the high-dose furosemide infusion in terms of clinical and diuretic response in patients hospitalized for ADHF. More importantly, however, the combination of low-dose furosemide and low-dose dopamine infusion is associated with significantly lower rates of WRF than high-dose furosemide, suggesting a renoprotective effect in this patient population.

Although a clear signal

Disclosures

None.

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