1. Background
Acute kidney failure (acute renal injury) is a condition in which kidneys cannot preserve the normal homeostasis of electrolytes and water. Kidney failure occurs when the kidneys are unable to excrete metabolic wastes or perform regulatory functions (1). In acute renal failure, substances that are naturally excreted in the urine accumulate in body fluids, causing endocrine and metabolic dysfunction as well as impaired water and electrolyte regulation and acidosis. Kidney failure, as an acute or chronic condition, manifests to oliguria or anuria (2, 3).
Oliguria, as urination less than 1 cc/k/h, occurs in 25% of male and 7% of female infants during labor. Approximately 95% of healthy and premature infants urinate in the first 24 hours and 98% in the first 48 hours of birth (4). Accordingly, the importance of oliguria and anuria is determined. For a proper treatment of a patient with acute renal failure (ARF), fluids should be consumed, and the rate of urinary excretion should be carefully monitored (5). Energy intake should be 35 - 50 Kcal/kg/day, and salt intake should be up to 2 to 4 g/day. In addition to fluids, diuretics, such as furosemide infusion, are also used. Dopamine at a low dose of 3 µg/kg/min can preferably dilate the renal arteries and lead to diuresis when a person is unresponsive to dopamine, it is recommended to dialysis (6, 7). Based on the etiology of oliguria and anuria, different therapeutic methods are used.
2. Objectives
The aim of this study was to compare dopamine and drip Lasix efficacy in children with oliguria.
3. Methods
This study was performed to evaluate dopamine and furosemide efficacy on renal function in oliguria cases. In this study, patients with oliguria or anuria in Amirkabir hospital in Arak, whose urine volume were less than 1 mL/kg/h and met the inclusion criteria, were included in the study. These cases were the hospitalized children who were admitted to NICU, PICU, and the wards of infants and pediatrics. In total, 60 cases with oliguria were required to be studied, based on the inclusion criteria. Then, cases were randomly divided into two groups, and their urinary volume improvement was assessed after the treatment.
In the first group, dopamine was administered at a dose of 3 µg/kg/min, and in the second group, Lasix drip was administered at a dose of 0.05 mg/kg/h. Then, the improvement of urinary volume in the two groups of patients was evaluated after drug administration. For this purpose, the patients' urine volume was evaluated in 4 - 6 hours intervals, and the recovery rate was recorded.
3.1. Statistical Analysis
After collecting the data, they were analyzed with SPSS software (version 23) using Chi-square (Qualitative data) and Independent Sample T-test (Quantitative data).
4. Results
Of 60 evaluated cases with oliguria [dopamine (n = 30) and Lasix (n = 30) groups], the mean and standard deviation (SD) of age in total, dopamine, and drip Lasix groups were 2.76 ± 1.85, 2.83 ± 1.93, and 2.70 ± 1.81 years, respectively (P = 0.74), as well as in gender, 31 cases (51.7%) in total, 17 cases (56.7%) in the dopamine group, and 14 cases (46.7%) in the Lasix group were female, and the others were male (P = 0.43) (Table 1). The values of indicators related to the improvement of urinary status, including creatinine, sodium, potassium, time of first urination, and the amount of enhancement in urine volume before and after the treatment, are also seen in Table 2 and 3. Based on statistical evaluations, these indices did not show a statistically significant difference between the two groups before and after the treatment (P > 0.05).
Table 2.Creatinine, Urea, and Electrolytes Before and After Treatment in Two Groups
| Variables | Group | P-Value a | ||
|---|---|---|---|---|
| Dopamine | Lasix Drip | Total | ||
| Creatinine (mean ± SD) | 0.84 | |||
| Before | 1.36 ± 0.31 | 1.24 ± 0.25 | 1.30 ± 0.28 | |
| After | 0.87 ± 0.20 | 0.84 ± 0.17 | 0.85 ± 0.19 | |
| Urea (mean ± SD) | 0.65 | |||
| Before | 40.56 ± 1.19 | 40.53 ± 1.13 | 40.54 ± 1.16 | |
| After | 23.83 ± 4.45 | 23.73 ± 4.45 | 23.78 ± 4.45 | |
| Sodium (mean ± SD) | 0.56 | |||
| Before | 141.96 ± 1.42 | 141.70 ± 1.53 | 141.83 ± 1.48 | |
| After | 140.70 ± 1.72 | 140.93 ± 1.55 | 140.81 ± 1.64 | |
| Potassium (mean ± SD) | 0.68 | |||
| Before | 3.98 ± 0.11 | 4.00 ± 0.21 | 3.99 ± 0.16 | |
| After | 4.16 ± 0.24 | 4.09 ± 0.21 | 4.12 ± 0.22 | |
a Using Independent Sample T-test
Table 3.Urination Condition of Evaluated Cases in Two Groups
| Variables | Group | P-Value a | ||
|---|---|---|---|---|
| Dopamine | Lasix Drip | Total | ||
| Time of first urination | 0.97 | |||
| Mean | 16.56 | 16.50 | 16.53 | |
| SD | 9.13 | 9.19 | 9.08 | |
| Urine Volume | 0.42 | |||
| Mean | 7.34 | 6.83 | 7.08 | |
| SD | 2.69 | 2.16 | 2.44 | |
a Using Independent Sample T-test
5. Discussion
Oliguria, as urine excretion less than 1 cc/kg/h, may be due to acute kidney injury (AKI). Approximately 25% of male and 7% of female infants urinate during labor, and approximately, 95% of healthy and premature infants urinate in the first 24 hours and 98% in the first 48 hours of birth. Accordingly, urine volume reduction is determined. For a proper treatment of a neonate and child with acute renal failure (ARF), fluids should be consumed, and the rate of urine excretion should be carefully monitored. Treating these patients is often challenging, which highlights the importance of paying attention to new treatments.
In the current study, we observed that the mean ± SD of creatinine in children after receiving dopamine and drip Lasix was 0.87 ± 0.2 mg/dl and 0.84 ± 0.17 mg/dl, respectively. Also, other evaluated indices, including urea, sodium, potassium, the rate of urine improvement, and volume of urine improvement, did not show statistically significant differences in the two groups; thus, dopamine and drip Lasix had similar performance in neonates with oliguria and anuria.
Keiseb et al. examined the effects of dopamine and furosemide on patients with oliguria and observed that the recovery rate was 20% in 80 cases at 4 hours of a period of follow-up. Also, they mentioned that there was no statistically significant difference in the mean of urine output, change in urine output and the mean of urea and creatinine in both groups (8). Moreover, Bell et al., regarding the effect of dopamine on oliguria, reported that the two groups were similar in baseline characteristics and renal function. They also stated that there was not a statistically significant difference between the dopamine and placebo groups in the serum creatinine concentration (9). In another study, Sirivella et al. stated that injection of mannitol, furosemide, and dopamine in three groups increased diuresis in patients with postoperative renal failure while decreased the need for dialysis in most patients (10). Lindner et al., regarding the therapeutic effects of furosemide and dopamine combination, stated that this combination was uniformly associated with the reduction of serum creatinine levels (11). Also, Lassnigg et al. examined the efficacy of dopamine or furosemide in the prevention of AKI after cardiac surgery and found that plasma creatinine enhancement was twice as high in the furosemide group compared with dopamine and placebo groups (P < 0.01) (12). Based on the discussed studies that were consistent with the results of the present study, dopamine and drip Lasix could improve patients’ condition with oliguria and anuria.
5.1. Conclusion
Based on the present study and in comparison to other studies in this field, both drip Lasix and dopamine improved the condition of patients with oliguria. In addition, there was no statistically significant difference between these two drugs, so both drugs could improve the condition of patients; however, further studies are needed to compare two drugs in oliguria and anuria.
