Comparison of systemic and renal effects of dopexamine and dopamine in norepinephrine-treated septic shock

Objectives: Vasopressor-induced vasoconstriction may compromise renal and splanchnic blood flow in patients with septic shock, resulting in secondary organ failures. The authors compared the effects of the vasodilatatory agent dopexamine against renal-dose dopamine and placebo in patients with norepinephrine therapy and septic shock, using 24-hour serum creatinine clearance (C-crea) as a major endpoint. The primary hypothesis to be tested was that dopexamine is more effective than dopamine and that dopamine shows better effects than placebo regarding organ failures and C-crea. Design: A prospective, randomized, controlled, double-blinded study. Setting: Intensive care unit in a tertiary care university hospital. Participants: Sixty-one patients with septic shock defined according to established criteria. Interventions: Patients received either dopexamine (2 mu g/kg/min, n = 20), dopamine (3 mu g/kg/min, n = 21), or placebo (n = 20). Results: The trial groups were similar in terms of baseline characteristics. The authors found no significant differences among the dopexamine, dopamine, and placebo groups with regard to a comprehensive number of renal function parameters including C-crea and organ-failure scores. There was a significant increase in heart rate after dopexamine infusion; other hemodynamic parameters remained unchanged in the dopexamine group. In a post hoe analysis that included only patients with renal impairment at study inclusion (n = 28), patients who received dopamine showed significant improvements in C-crea when compared with placebo. Dopexamine was not effective in this subgroup. Conclusions: Dopexamine is no more effective than dopamine or placebo regarding renal function in patients with septic shock requiring norepinephrine. Both therapies do not influence organ-failure scores. (c) 2006 Elsevier Inc. All rights reserved.