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Low-dose dopamine is not useful in kidney transplantation

Introduction

In kidney transplantation, low-dose dopamine (LDD) (0.5 to 2.5 μg/kg/min) is used to increase urine output and to prevent arterial vasospasm and acute tubular necrosis, but there is some controversy about its use [14]. The aim of the study was to evaluate the effectiveness of LDD in the early post-transplant period.

Methods

Fifty kidney transplant recipients admitted to the ICU in the early post-transplant period were allocated to two groups: A (n = 20) treated and B (n = 30) not treated with LDD. All patients underwent postoperative intensive monitoring, control of blood sample and kidney functioning at 0, 6 and 12 hours in the ICU. Postoperative therapy was the same for all patients, except for LDD. The intravascular volume was kept effective by maintaining central venous pressure >5 mmHg and ScVO2>70%. We collected donors' and transplant kidney parameters (age, sex, death cause, ischaemia time), recipients' parameters (age, sex, weight, height, BMI, duration of dialysis, end stage renal disease, Simplified Acute Physiology Score II), intraoperative parameters (metabolic, respiratory and hemodynamic), hemodynamic and kidney functioning parameters in the ICU (heart rate, mean arterial pressure, central venous pressure, ScVO2, lactate, diuresis, blood urea nitrogen, creatinine, fluid balance), and outcome parameters (ICU length of stay, postoperative complications, acute rejection at 28 days, mortality at 6 months).

Results

There were no significant difference in donors' and graft data, recipients' data, intraoperative data, hemodynamic and kidney functioning data and outcomes in both groups. The significant differences between the two groups of patients were: Simplified Acute Physiology Score II was higher in group B (A: 24.4 ± 12.9; B: 31.2 ± 9.4; P < 0.05); heart rate was higher in group A at each observation time (at 6 hours A: 94.2 ± 17.03; B: 85.6 ± 12.2; at 12 hours A: 92.7 ± 15.5; B: 82.6 ± 15.2; P < 0.05); ICU length of stay was shorter in group B (A: 28.9 ± 17.3; B: 20 ± 7.2; P < 0.05).

Conclusion

LDD in kidney transplantation does not improve kidney function during the postoperative period, nor short-term and medium-term outcome, but it increases the heart rate and ICU length of stay.

References

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    Dalton R, et al.: Transplantation. 2005, 79: 1561-1567. 10.1097/01.TP.0000158431.81676.C4

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    Flancbaum L, et al.: Clin Transplant. 1998, 12: 256-259.

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    Spicer ST, et al.: Clin Transplant. 1999, 13: 479-483. 10.1034/j.1399-0012.1999.130607.x

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Ciapetti, M., Di Valvasone, S., Bonizzoli, M. et al. Low-dose dopamine is not useful in kidney transplantation. Crit Care 13, P177 (2009). https://doi.org/10.1186/cc7341

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Keywords

  • Kidney Transplantation
  • Central Venous Pressure
  • Acute Rejection
  • Ischaemia Time
  • Acute Tubular Necrosis