Use of dopamine in acute renal failure: A meta-analysis

Objective. To determine whether low-dose dopamine administration reduces th e incidence or severity of acute renal failure, need for dialysis, or morta lity in patients with critical illness. Data Sources and Study Selection: We performed a MEDLINE search of literatu re published from 1966 to 2000 for studies addressing the use of dopamine i n the prevention and/or treatment of renal dysfunction. Data Extraction: Data were abstracted regarding design characteristics, pop ulation, intervention, and outcomes. Results of individual randomized clini cal trials were pooled using a fixed effects model and a Mantel-Haenszel we ighted chi-square analysis. Data Synthesis., We identified a total of 58 studies (n = 2149). Of these, outcome data were reported in 24 studies (n = 1019) and 17 of these were ra ndomized clinical trials (n = 854). Dopamine did not prevent mortality, (re lative risk, 0.90 [0.44-1-83]; P = .92), onset of acute renal failure (rela tive risk, 0.81 [0.55-1.19]; p = .34), or need for dialysis, (relative risk , 0.83 [0.55-1.24]; p = .42). There was sufficient statistical power to exc lude any large (> 50%) effect of dopamine on the risk of acute renal failur e or need for dialysis. Conclusions. The use of low-dose dopamine for the treatment or prevention o f acute renal failure cannot be justified on the basis of available evidenc e and should be eliminated from routine clinical use.