Type 2 CRS is defined as renal detoriation due to chronic heart failure. because of chronic fluid overload due to CHF, renal venose pressure is increased. thus glomerular filtration rate is decreased. if we use of dopamine in 2 mg/kg/min dosage, afferent arteriol would dilated and GFR would be increased. Is it like this indeed? is there anyone who had experience use of dopamine (2 mg/kg/min) in Type 2 Cardio Renal Syndrome?
Hi Mustafa,
I used dobutamine 5ug/kg/min in chronic heart failure mice. Check if it is of any help.
http://www.ncbi.nlm.nih.gov/pubmed/16699071
Though it is written in Harrison Internal of Medicine textbook. Practically i never use it again in my practice. To reduce venous pressure, we use combination between furosemide and milrinone to reduce pulmonary artery pressure and increase left atrium preload and reduce body volume status.
i also enclose the link for a therapeutic option in cardiorenal syndrome
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3010630/pdf/IJN2011-194910.pdf
hope it helps
There is a good recent review covering this issue.
http://www.ncbi.nlm.nih.gov/pubmed/25414321
This corresponds to my experience that in some of these patients you can achieve a good diuretic effect by using low dose dopamine.
Best regards
The efficiency in acute heart failure is highly questionable and most probably low dose of dopamine are useless in this clinical situation. In chronic heart failure it could be different, but we must be careful and precise before drawing any conclusion.
Low dose of Dopamine (2ug/kg/min were extensively used in the past to improve diuresis and kidney function mainly during acute heart failure. However, few study, if any had demonstrated or even suggested its efficiency.
There was methodological flaws in clinical works:
- Many works were performed with dose likely to have an inotropic effect (5ug/kg/mn) and in clinical practice furosemide was frequently added. Therefore it has been impossible to have a clear idea on the efficiency of low dose of Dopamine.
May I suggest to look at these two recent articles?
JAMA. 2013 Dec 18;310(23):2533-43. doi: 10.1001/jama.2013.282190.
Low-dose dopamine or low-dose nesiritide in acute heart failure with renal dysfunction: the ROSE acute heart failure randomized trial.
Curr Opin Crit Care. 2014 Oct;20(5):467-71. doi: 10.1097/MCC.0000000000000133.
Is there still a role for low-dose dopamine use in acute heart failure?
Torres-Courchoud I1, Chen HH.
First of all, Dr Yaprak, do you mean '2 mg/kg/min' or do you mean '2 micro g/kg/min'? 2 mg is a very large dose.
2nd, dopamine has 'theoretical therapeutic effects' claimed for it from laboratory experiments in various animal models. However, none of these 'wonderful' effects has ever translated into clinical efficacy or beneficial therapeutic effects. Small dose dopamine infusion (2.5 micro g/kg/minor less will cause diuresis; however, if that is beneficial in heart failure or cardio-renal syndrome is highly questionable. There are alternatives to lowering venous pressure by other pharmacological means. Renal vaso-dilatation by low dose dopamine has not bee shown to be of any therapeutic value clinically.
Thank you very much Dr. Kishen for your answer, sorry my mistake, of course I mean that 2 mcg/kg/minute. In some patients, espacially in type 2 CRS, When the patient had not adequate urination, I used dopamine in dose of 2 mcg/kg/minute, and urine started, patient did not need HD or isolated UF.
I have some experiences with Dopamine when the patient lower diuresis and results are good, but it depends on lot of other comorbidity.
See the relevant chapter in my wonderful new book. CARDIORENAL CLINICAL CHALLENGES. Eds Goldsmith, Covic, Spaak. Published by Springer Jan 2015.
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