• 
• 

Three Part Question

In [adults (18+) presenting to the A&E with suspected acute renal failure] does [an infusion of dopexamine] improve [renal recovery and prognosis]?

Clinical Scenario

A patient under your care is diagnosed with acute renal failure. You have read the most recent BETs on dopamine, but you wonder if dopexamine may have different results. You investigate.

Search Strategy

Medline (1950- July 2007) using the OVID interface
[acute kidney failure.mp OR exp Kidney Failure, Acute/] AND [exp Dopamine/ OR dopexamine.mp] limit to humans and english language

Search Outcome

149 papers were found, of which 6 were relevant. One was a meta analysis that included four of the other papers, and one was discarded due to poor quality.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Renton et al	21 papers on the effects of dopexamine in a number of clinical situations. The findings with regards to renal perfusion were identified.	Meta-analysis	Dopexamine infusion given	No significant changes in creatinine clearance or prognosis	Poor evidence base to look at

Comment(s)

There is a very poor evidence base on the use of dopexamine in renal patients. Despite promising laboratory results, the available clinical evidence shows no significant changes. Although more evidence is needed to say conclusively that dopexamine does not have any renal protective effect, it is likely that more evidence will show conclusively that it does not.

Clinical Bottom Line

Dopexamine cannot be recommended for use in patients with acute renal failure.

References

1. Renton et al Dopexamine and its role in the protection of hepatosplanchnic and renal perfusion in high-risk surgical and critically ill patients Br J Anaesth 94(4); 459-67