Abstract 3707: Dopamine Prevents Worsening of Renal Function and Hypokalemia During Hospitalization for Acute Decompensated Heart Failure
Background: Worsening renal function (WRF) and hypokalemia related to diuretic use for acute decompensated heart failure (ADHF) are common and portend poor prognosis. Whether dopamine infusion aids diuresis without exacerbating these risks is not known.
Methods: Fifty consecutive patients (age 76.8±10.4 years; 58% female; ejection fraction 35.7±12.5%) were randomized to compare the effects of high-dose furosemide (HDF, furosemide 20 mg/h intravenously) vs. low-dose furosemide combined with low-dose dopamine (LDFD, furosemide 5 mg/h plus IV dopamine 5μg/kg/min intravenously) on diuresis, renal function, electrolyte balance, and 60-day post-discharge outcomes.
Results: Urine volume/hour for the first 8 hours was numerically but non-statistically significantly higher in LDFD group (362±210ml in HDF vs. 472±407ml in LDFD group, p=0.35). Changes in dyspnea score were similar between the two groups (Borg index at 24 hours −4.9±1.9 in HDF vs. −4.5±1.6 in LDFD group; p=0.58). WRF was less commonly seen in LDFD group (4% vs. 36% for HDF, p=0.005 when defined as either sCr rise >0.3 mg/dl or >25% from baseline; Table⇓). Hypokalemia was less frequent in the LDFD group [decrease in serum potassium from baseline: 4.5±0.5 to 4.2±0.5 mEq/l in LDFD vs. 4.4±0.4 to 3.8±0.4 mEq/l, p=0.015; hypokalemia (<3.5 mEq/l) 0% in LDFD vs. 8% in HDF, p=0.025]. Length of stay was similar in the two groups (6.1±2.5 vs. 6.2±2.1 days, p=0.948). None of the 60 day outcomes (all-cause, cardiovascular, non-cardiovascular, and due to worsening HF) differed between the two groups.
Conclusion: The combination of low dose furosemide and dopamine was equally effective and safer than high dose furosemide infusion. Larger studies are needed to confirm these findings and elucidate the effect of dopamine on renal function in ADHF patients.