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Circulation. 2008;117:200-205
Published online before print January 2, 2008, doi: 10.1161/CIRCULATIONAHA.107.737106
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 Circulation: January 15, 2008, Volume 117, Number 2
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(Circulation. 2008;117:200-205.)
© 2008 American Heart Association, Inc.

Heart Failure

Renal Vasodilatory Action of Dopamine in Patients With Heart Failure

Magnitude of Effect and Site of Action

Uri Elkayam, MD; Tien M.H. Ng, PharmD; Parta Hatamizadeh, MD; Munir Janmohamed, MD; Anilkumar Mehra, MD

From the Heart Failure Program, Division of Cardiovascular Medicine, University of Southern California, Keck School of Medicine, Los Angeles, Calif.

Reprint requests to Uri Elkayam, MD, Director, Heart Failure Program, Los Angeles County/University of Southern California Medical Center, 1200 N State St, Room 7621, Los Angeles, CA 90033. E-mail elkayam{at}usc.edu

Received June 25, 2007; accepted October 31, 2007.

Background— A "renal dose" of dopamine is often used to increase renal blood flow; however, data on the magnitude of effect and site of action in patients with heart failure are scarce.

Methods and Results— Renal effects of intravenous dopamine (1, 2, 3, 5, and 10 µg · kg–1 · min–1) were evaluated in 13 patients with chronic heart failure. Renal blood flow was calculated from renal artery cross-sectional area measured with intravascular ultrasound and renal blood flow velocity-time integral measured by the intravascular Doppler technique. Cross-sectional area increased and was significantly higher than baseline (0.30±0.04 cm2) at 5 µg · kg–1 · min–1 (0.36±0.05 cm2) and 10 µg · kg–1 · min–1 (0.38±0.06 cm2). The velocity-time integral was significantly higher than baseline (22±3 cm) at doses of 3 and 5 µg · kg–1 · min–1 (both 31±4 cm). Renal blood flow increased, whereas renal vascular resistance decreased, reaching statistical significance at 2 µg · kg–1 · min–1 through 10 µg · kg–1 · min–1. Cardiac output gradually increased, reaching statistical significance at doses of 5 and 10 µg · kg–1 · min–1 (5.5±0.5 and 6.1±0.7 versus 4.5±5.2 L/min at baseline), but the increase in renal blood flow appeared proportionately larger than corresponding increases in cardiac output.

Conclusions— Dopamine is associated with an increase in renal blood flow in patients with heart failure. This effect is due to dilation of both the large conductance and small resistance renal blood vessels. Further evaluation of the efficacy and safety of dopamine for improvement of renal function in hospitalized patients with heart failure is warranted.

 

CLINICAL PERSPECTIVE


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Clinical Summaries
Circulation 2008 117: 127. [Extract] [Full Text]



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