comparison between effects of dopamine and dopamine analogue during the early stages of sepsis- induced renal dysfunction

ABSTRACT

Vasopressor-induced vasoconstriction may compromise renal and splanchnic blood flow in patients with septic shock, resulting in secondary organ failure. The author compared the effects of the vasodilatatory agent dopexamine against a renal-dose of dopamine and placebo in patients with early stages of sepsis-induced renal dysfunction on norepinephrine therapy, using 24-hour serum creatinine clearance [C[crea]] as a major endpoint. The primary hypothesis to be tested was that dopexamine is more effective than dopamine and that dopamine shows better effects than placebo regarding organ failure and C[crea] This is a prospective, randomized, controlled double-blinded study, done in the intensive care unit of Alain Hospital, UAE. Sixty-one patients with septic shock defined according to established criteria. Patients received either dopexamine [2 micro g-.kg[1], min1], n=20], dopamine [3 micro g.kg[1] min[-1], min[-1], n = 21], or placebo [n = 20]. The trial groups were similar in terms of baseline characteristics. The author found no significant differences among the dopexamine, dopamine, and placebo groups with regard to a comprehensive number of renal function parameters including C[crea] and organ-failure scores. There was a significant increase in heart rate after dopexamine group. In a post hoc analysis that included only patients with renal impairment at study inclusion [n=28], patients who received dopamine showed significant improvements in C[crea] when compared with placebo. Dopexamine was not effective in this subgroup. Dopexamine is no more effective than dopamine or placebo regarding renal function in patients with early stages of sepsis-induced renal dysfunction requiring norepinephrine. Both therapies do not influence organ-failure scores