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Evaluation of HFpEF Patients With Acute HF and Dopamine
Study Questions:
Is a continuous infusion diuretic strategy compared to an intermittent bolus one, with or without the use of a low-dose dopamine infusion, associated with improved renal function in patients with heart failure with preserved ejection fraction (HFpEF) admitted with HF exacerbation?
Methods:
ROPA-DOP was an open-label, single-center trial, which randomized 90 patients in a 1:1:1:1 ratio to one of four treatment strategies: 1) intermittent bolus furosemide (every 12 hours), 2) continuous infusion furosemide, 3) intermittent bolus plus low-dose intravenous dopamine (3 μg/kg/min), and 4) continuous infusion plus low-dose intravenous dopamine. The primary endpoint was the % change in creatinine at 72 hours post-admission.
Results:
The continuous infusion strategy was associated with a 16% increase in creatinine at 72 hours compared to 4.6% in the intermittent bolus treatment strategy (p = 0.02). There were no statistically significant differences in the percent change in creatinine between the low-dose dopamine (12.8%) versus no dopamine (8.0%, p = 0.33).
Conclusions:
In HFpEF patients hospitalized with acute heart failure, a continuous diuretic infusion strategy compared to a bolus infusion one was associated with worsening renal function. Low-dose dopamine infusion had no significant impact on renal function with either strategies.
Perspective:
Limited conclusions can be derived from this unfortunately underpowered single-center study examining diuretic strategies and renoprotective dopamine infusion in patients with HFpEF. At best, the findings are consistent with trials in HF with reduced EF, showing worsening renal function with continuous infusion strategies and lack of benefit of low-dose dopamine infusion. Given the heterogeneity of HF patients, definitive answers on the risks or benefits of various diuretic and renoprotective strategies are bound to require a large number of participants. Until then and likely forever, a comprehensive and daily clinical assessment will remain our guide.
Keywords: Creatinine, Diuretics, Dopamine, Furosemide, Geriatrics, Heart Failure, Heart Failure, Diastolic, Renal Insufficiency, Stroke Volume, Treatment Outcome
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