Download presentation
Presentation is loading. Please wait.
Published byPeter Lee Modified over 9 years ago
1
Meta-Analysis: Low-dose dopamine Increases urine output but does not prevent renal dysfunction or death Annals of Internal Medicine 2005; 142: 510-524 Issaam Oozeerally
2
Dopamine Catecholamine Dose dependent effects on systemic and renal vasculature At low doses increases renal blood flow and promotes natriuresis [D1, D2, D4 receptors] 1 st clinical use in heart failure
3
Purpose Evaluate effects of low-dose dopamine c.f placebo /no therapy in patients with or at risk of ARF
4
Methods: Search strategy MEDLINE – 1966 –January 2005 EMBASE – 1980- January 2005 CINAHL – 1982 – January 2005 CANCERLIT – 1975 – Oct 2002 CENTRAL – 4 th quarter 2004 Renal Health library
5
Search: MEDLINE 1.Dopamine/low dose dopamine/renal dose dopamine – Limited to clinical trial and meta-analysis
6
MEDLINE Search no. 2 1 [Dopamine]2 [Renal disease]3 [physiology] LowKidney DiseasesKidney Function Tests RenalKidneyUrine KidneyRenal circulation Dose Limited to RCTs [maximally sensitive strategy]
7
Rest of the search Modification of search from other databases – Strategy not specified – Authors happy to be contacted Screened reference lists from articles against recent review articles to identify additional studies No language restrictions
8
Selection RCTs/quasi-randomization trials Any sample size Low dose dopamine vs. placebo/nil Outcomes: – All cause mortality – Requirement for RRT – Renal physiological variables [UO, Creat, CrCl day 1, 2, 3] – Adverse effects Studies with pharmacologic co-interventions [e.g. mannitol, diuretics] A priori adverse effects: – Ischaemia [myocardial, limb, cutaneous] or arrhythmias
9
Data Abstraction 2 independent reviewers Study authors contacted if any disagreement – Consensus if persisted Agreement for inclusion studies statistically tested [Cohen’s κ]
10
Validity assessment Individual studies methodology looked into – Randomization – Blinding – Outcome assessors – Reasons for withdrawals Fluids and diuretic therapies – Standard or equally applied in both arms Attempted to contact all authors of selected trials
11
Exclusion Criteria – 70 studies Small sample [3 patients] Dopamine dose >5mcg Not randomized cross-over study Combined intervention c.f control Duplicate Wrong topic Editorial 4 RCTs without group data available from authors No additional data provided
12
Hence 3359 patients identified in 61 trials
13
Data Analysis Pooled by outcome – E.g. mortality, RRT If different doses of dopamine used data was combined Random effects model used Binary outcomes [RRT, mortality, adverse effects] reported as relative risk Summary of relative risk : log scale – Used to calculate weight of study
14
Data Analysis [cont] If heterogeneity between studies; weight was adjusted Clinical outcomes occurred infrequently and different statistical tests i.e. effect measures were undertaken – Similar results [not presented]
15
Data Analysis [cont.] Renal physiologic outcomes: – Relative change in dopamine gp c.f. control Mean values were taken Lack of standardized data e.g. weight
16
Data Analysis [cont] Between study homogeneity for each pool – [concept when there is more variation than chance alone] – Calculated statistically [I 2 and Cochran Q-test]
17
Patient profile Cardiac surgery Vascular surgery Other surgery Iv Contrast dye Nephrotoxics Neonates Miscellaneous
18
Data Average numbers per trial 40 [12 to 347] ANZICS trial included [328 patients; multi- centre] Only 6 trials used dopamine therapeutically: – Critical illness, contrast, malaria, CHF, preeclampsia
19
Data Median dopamine dose 2.5 mcg 31 hours median [0.4 to 192 hours] 12 trials randomization not reported 11 trials fluids up to the clinician
20
Clinical outcomes No effect on mortality [0.96] or need for RRT [0.93] – No statistical evidence of heterogeneity ANZICS trial and most heavily weighted trial removed and data analysed again – No change
21
Mortality
22
RRT
23
Adverse effects Arrhythmias & ischaemia [cutaneous, myocardial, limb] 6 MI’s [4 on dopamine] Statistically not significant
24
Renal Physiologic Outcomes Statistically significant increase in urine output on day 1 Decrease in creat and increase in creat clearance on day 1 Substantial heterogeneity
25
Conclusion 24% increase in urine output on day 1 – Probably explains continued popularity ANZICS trial – same results ANZICS trial – removal of data Adverse effects – under reported
26
Discussion Methodology – Search strategies not specified – Age and sample size – Combining dopamine doses Stats – If no events arbitrary figure of 0.5 given – Study weight adjusted in presence of heterogeneity – Use of relative risk
Similar presentations
© 2025 SlidePlayer.com. Inc.
All rights reserved.