Low-Dose Dopamine Has Insignificant Impact on Renal Function, Diuresis

Low-dose dopamine in combination with either continuous infusion furosemide (CF) or intermittent bolus furosemide (IF) did not significantly impact diuresis in heart failure (HF) patients, according to results presented at the Heart Failure Society of America’s 21^st Annual Scientific Meeting in Dallas, Texas.

The Randomized Evaluation of Heart Failure with Preserved Ejection Fraction Patients with Acute Heart Failure and Dopamine (ROPA-DOP) trial randomized 90 patients 1:1:1:1 to 4 possible treatments, either IF or CF at 2 times the outpatient does without or with a 3 mcg/kg/min dose of dopamine (IF+DA and CF+DA, respectively). The treatment duration lasted 72 hours, with the primary endpoint being the percent change in creatinine.

“ROPA-DOP was the first randomized trial of inpatient management of acute decompensated heart failure with persevered ejection fraction,” Kavita Sharma (pictured), MD, lead author and advanced heart failure cardiologist at Johns Hopkins Heart and Vascular Institute, said. “We found that, with the secondary endpoint for the percent change in worsening renal function, the continuous infusion diuretic strategy was associated with worsening renal function in these patients.”

Continuous furosemide was found to be associated with a 16% change in creatinine compared to a 4.6% change with IF (p=0.02). When comparing the low-dose dopamine groups, the non-dopamine cohort saw an 8.0% change compared to a 12.8% change in the dopamine arm, a non-statistically significant difference (p=0.33).

When comparing worsening renal function, there was virtually no difference between the dopamine arms, as the non-dopamine arm saw a 23.8% change compared to a 25.0% change in the dopamine arm (=0.89). However, the CF group was associated with a 36.2% change in worsening renal function compared to an 11.6% change with IF (p<0.01)

Additionally, the volume of diuresis was consistent across all groups, with a mean of 10523.5 mL of urine. The IF group experienced a 10300-mL output compared to 10749 mL in the CF group (p=0.61), while dopamine versus non-dopamine also experienced little difference, comparing 10340 mL (non) with 10705 mL (with) (p=0.67).

“Half of the patients hospitalized with acute HF have a persevered ejection fraction (HFpEF), and that is associated with a high incidence of worsening renal function,” Sharma said. “There is anywhere from a 12% to a 40% increase. We sought to determine if either low-dose dopamine versus no dopamine, as well as CF versus IF, could augment diuresis without increasing the risk of renal impairment.”

Patients received an echocardiogram, pro-BNP test, 6-minute walk test, global well-being assessment, and blood and urine samples upon enrollment and at discharge. The pro-BNP levels, 6-minute walk test, and global well-being assessment were all reassessed at the 72-hour mark, as well as upon discharge from the facility.

The average patient age was 66, with 61% of the group being female, 56% black, 85% having hypertension, 53% with diabetes, and 32% with concurrent atrial fibrillation. The cohort was, uniquely, as a whole obese, with an average body mass index of 40.8.