Renal Effects of Added Low-dose Dopamine in Acute Heart Failure Patients With Diuretic Resistance to Natriuretic Peptide

Worsening renal function during the early phase of hospitalization is related to adverse outcomes in acute heart failure (AHF). This study aimed to clarify whether added low-dose dopamine (DA) is clinically beneficial for AHF patients with diuretic resistance to human atrial natriuretic peptide (hANP). Twenty-four AHF patients, who did not have adequate diuresis by 4 hours after administration of hANP, were randomized to a low dose of DA (1-3 gkg(-1)min(-1), n = 12) or a low dose of furosemide (10-30 mg injection, n = 12). The significant increase in mean hourly urine volume from baseline (265% +/- 204% with hANP + DA; 187% +/- 118% with hANP + furosemide) and improvement of dyspnea were similarly observed in both groups. Significant decreases in serum creatinine levels were observed by -14.0% +/- 14.2% in the hANP + DA group compared with the hANP + furosemide group (4.5% +/- 9.6%, P = 0.0011) without increases in the renotubular and myocardial markers. The incidence of worsening renal function defined as a rise in serum creatinine of >0.3 mg/dL was not observed within 3 days of admission in both groups. Added low-dose DA might not have a harmful effect on renal function and effects of diuresis and symptom relief without a significant increase in troponin-T in AHF patients with diuretic resistance to hANP.