Milrinone vs Dobutamine for the Management of Cardiogenic Shock: Implications of Renal Function and Injury.
acute kidney injury
cardiogenic shock
inotropes
renal dysfunction
Journal
JACC. Advances
ISSN: 2772-963X
Titre abrégé: JACC Adv
Pays: United States
ID NLM: 9918419284106676
Informations de publication
Date de publication:
Jul 2023
Jul 2023
Historique:
received:
28
06
2022
revised:
22
03
2023
accepted:
06
04
2023
medline:
28
6
2024
pubmed:
28
6
2024
entrez:
28
6
2024
Statut:
epublish
Résumé
Cardiogenic shock is associated with poor clinical outcomes. There is a paucity of prospective data examining the efficacy and safety of inotropic therapy in patients with cardiogenic shock and renal dysfunction. This study sought to examine the treatment effect of milrinone compared to dobutamine in relation to renal function. In this post hoc analysis of the DOREMI (Milrinone as Compared with Dobutamine in the Treatment of Cardiogenic Shock) trial, we examined clinical outcomes with milrinone compared to dobutamine after stratification based on baseline estimated glomerular filtration rate (eGFR) 60 ml/min/1.73 m Baseline eGFR <60 ml/min/1.73 m In patients requiring inotropic support for cardiogenic shock, baseline renal dysfunction and AKI are common. A modulating effect of AKI on the relative efficacy of milrinone compared to dobutamine was observed, characterized by attenuation of a potential clinical benefit with milrinone compared to dobutamine in patients who develop AKI.
Sections du résumé
Background
UNASSIGNED
Cardiogenic shock is associated with poor clinical outcomes. There is a paucity of prospective data examining the efficacy and safety of inotropic therapy in patients with cardiogenic shock and renal dysfunction.
Objectives
UNASSIGNED
This study sought to examine the treatment effect of milrinone compared to dobutamine in relation to renal function.
Methods
UNASSIGNED
In this post hoc analysis of the DOREMI (Milrinone as Compared with Dobutamine in the Treatment of Cardiogenic Shock) trial, we examined clinical outcomes with milrinone compared to dobutamine after stratification based on baseline estimated glomerular filtration rate (eGFR) 60 ml/min/1.73 m
Results
UNASSIGNED
Baseline eGFR <60 ml/min/1.73 m
Conclusions
UNASSIGNED
In patients requiring inotropic support for cardiogenic shock, baseline renal dysfunction and AKI are common. A modulating effect of AKI on the relative efficacy of milrinone compared to dobutamine was observed, characterized by attenuation of a potential clinical benefit with milrinone compared to dobutamine in patients who develop AKI.
Identifiants
pubmed: 38938997
doi: 10.1016/j.jacadv.2023.100393
pii: S2772-963X(23)00235-1
pmc: PMC11198346
doi:
Types de publication
Journal Article
Langues
eng
Pagination
100393Informations de copyright
© 2023 The Authors.
Déclaration de conflit d'intérêts
Funded by the Innovation Fund of the Alternative Funding Plan for the Academic Health Sciences Centres of Ontario. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.PERSPECTIVESCOMPETENCY IN MEDICAL KNOWLEDGE: Renal dysfunction is a prevalent comorbidity and a common sequelae of end-organ hypoperfusion in patients with cardiogenic shock. Significant renal dysfunction is both an indicator and a mediator of a worse prognosis in patients with cardiogenic shock and an important clinical consideration when choosing pharmacotherapies and timing interventions requiring iodinated-contrast agents. At present, there is a paucity of prospective data examining the relative efficacy and safety of milrinone in patients with cardiogenic shock and renal dysfunction. TRANSLATIONAL OUTLOOK: Future studies should further explore the association between milrinone and outcomes in patients with cardiogenic shock and renal dysfunction.