Efficacy of low-dose dopamine in preventing amphotericin B nephrotoxicity in bone marrow transplant patients and leukemia patients

This study evaluated the efficacy of low-dose dopamine for prevention of am photericin B-induced nephrotoxicity in autologous bone marrow transplant an d leukemia patients. Seventy-one patients undergoing cytoreductive therapy who required amphotericin B were randomly assigned in an unblinded fashion to a group receiving continuous-infusion low-dose dopamine (3 mu g/kg/min) or a group receiving no dopamine. Amphotericin B was dosed at 0.5 or 1.0 mg /kg/day based on computerized tomography scan results or presence of positi ve blood cultures. No patient received saline boluses. The rate of nephroto xicity, severity as graded by Southwest Oncology Group toxicity criteria, a nd time to each grade of nephrotoxicity were compared between the two group s. Eighty percent of the no dopamine group and 66.7% of the dopamine group developed nephrotoxicity, defined as a 1.5-fold or greater increase in base line serum creatinine level (P = 0.20). No statistical difference was noted at any grade of nephrotoxicity between the two groups. Thirty-four percent of patients in the no-dopamine group versus 17.6% in the dopamine group ha d a 2.5-fold or greater increase in serum creatinine level, which was not s tatistically significant (P = 0.0888). Ten patients developed grade IV neph rotoxicity and were withdrawn from the study, 7 in the no-dopamine group an d 3 in the dopamine group (P = 0.19). The time to each grade of nephrotoxic ity was also not significantly different for the two groups. Eleven adverse drug reactions were reported in the dopamine group in comparison to one in the no-dopamine group. Thus, dopamine offers little in the way of preventi on of nephrotoxicity associated with amphotericin B therapy. Although the s ignificance of drug reactions in the dopamine group is not clearly establis hed due to lack of cardiac monitoring in the no-dopamine group, dopamine th erapy is not without complications.