Research

Systematic review: The use of diuretics and dopamine in acute renal failure: a systematic review of the evidence

John A Kellum

University of Pittsburgh Medical Center, Division of Critical Care Medicine, 200 Lothrop Street, Pittsburgh, PA 15213-2582, USA

author email

Critical Care 1997, 1:53-59doi:10.1186/cc103

Published:	26 November 1997

Abstract

Objective

To evaluate the impact of diuretics and dopamine for both the prevention and treatment of renal dysfunction in the acute care setting.

Study identification and selection

Studies were identified via MEDLINE, and through bibliographies of primary and review articles. Articles were then screened by the author for studies addressing the use of diuretics or dopamine in the prevention and/or treatment of renal dysfunction.

Data abstraction and literature appraisal

From individual studies, data were abstracted regarding design features, population, intervention and outcomes. Studies were graded by levels according to their design.

Results

A total of 10 studies using diuretics and 30 involving dopamine were identified. Level I evidence exists against the use of diuretics for radiocontrast-induced acute tubular necrosis, and loop diuretics given after vascular surgery. There is level II evidence that diuretics do not improve outcome in patients with established acute renal failure. Level II evidence also exists against the use of dopamine in the prevention of acute tubular necrosis in multiple subsets of patients.

Conclusions

Routine use of diuretics or dopamine for the prevention of acute renal failure cannot be justified on the basis of available evidence.