Low dose dopamine as a preventive measure against radiocontrast-induced nephropaty among patients undergoing coronary angiography: A meta-analysis.

Backgound: Radiocontrast-induced nephropathy is the third leading cause of in-hospital acute renal failure. As the use of coronary angiography is becoming widespread, an increase in the incidence of contrast-related acute renal failure is expected as long as no completely effective means is available to avert its development. Previous studies evaluating the potential benefits of singular prevention strategies have failed to show clear benefits across a spectrum of patients at risk, in recent years, low dose dopamine has been investigated as preventive strategy in many studies but results are contrasting and therefore of uncertain benefit. (Author)

Objectives: A meta-analysis of available literature was undertaken to evaluate the effects of low dose dopamie among patients undergoing coronary angiography in terms of preventing radio-contrast induced nephropathy and acute renal failure requiring dialysis, and reducing the duration of hospitalization post-procedure.

Data Sources: Available medical literature identified by searching MEDLINE, PubMed and Cochrane Controlled Trials Register, Cochrane Library. Cross-references of the retrieved articles were likewise reviewed to check for other pertinent studies.

Data Extraction: Incidence rates of radiocontrast-induced nephropathy and acute renal failure requiring dialysis, lenght of hospitalization, data on mean change in serum creatinine levels at 24 hours and 48 hours after coronary angiography were extracted.

Results: Five studies involving 274 patients (dopamine=131, control=143) were included. The over all odds ratio of radiocontrast-induced nephropathy at 48 hours was 1.31 (95 percent Cl 0.72 to 2.38, p value 0.4) while that of acute renal failure requiring dialysis was 1.40 (95 percent Cl 0.43 to 4.59, p value 0.35). The overall weighted mean difference (WMD) for mean change in serum creatine at 24 hours and 48 hours after angiography were 0.00 mg percent (95 percent Cl - 0.04 to 0.04, p = 1.0) and 0.08 mg percent (95 percent Cl 0.07 to 0.09, p <0.005), respectively. The WMD for mean length of hospitalization post-procedure was - 0.13 days (95 percent Cl -1.78 to 1.52, p=0.1).

Conclusions: Low dose dopamine offered no clear benefit in preventing radiocontrast-induced nephropathy or acute renal failure requiring dialysis in patients undergoing coronary angiography nor did it shorten duration of post-procedure hospitalization.