Intraoperative hemodynamic factors predicting early postoperative renal function in pediatric kidney transplantation

To determine whether low-dose dopamine administration reduces the incidence or severity of acute renal failure, need for dialysis, or mortality in patients with critical illness. We performed a MEDLINE search of literature published from 1966 to 2000 for studies addressing the use of dopamine in the prevention and/or treatment of renal dysfunction. Data were abstracted regarding design characteristics, population, intervention, and outcomes. Results of individual randomized clinical trials were pooled using a fixed effects model and a Mantel-Haenszel weighted chi-square analysis. We identified a total of 58 studies (n = 2149). Of these, outcome data were reported in 24 studies (n = 1019) and 17 of these were randomized clinical trials (n = 854). Dopamine did not prevent mortality, (relative risk, 0.90 [0.44-1.83]; p =.92), onset of acute renal failure (relative risk, 0.81 [0.55-1.19]; p =.34), or need for dialysis, (relative risk, 0.83 [0.55-1.24]; p =.42). There was sufficient statistical power to exclude any large (>50%) effect of dopamine on the risk of acute renal failure or need for dialysis. The use of low-dose dopamine for the treatment or prevention of acute renal failure cannot be justified on the basis of available evidence and should be eliminated from routine clinical use.