Effect of Levosimendan on Estimated Glomerular Filtration Rate in Hospitalized Patients with Decompensated Heart Failure and Renal Dysfunction

Abstract

SUMMARYBackground: Only limited data of the long-term effect of levosimendan on renal dysfunction in patients with decompensated heart failure (DHF) have been published previously. To date, there has been no similar study carried out in a Chinese population. Design and Methods: A prospective, randomized, placebo-controlled, and double-blind study was performed to investigate the effect of levosimendan on estimated glomerular filtration rate (eGFR) in DHF patients with renal dysfunction during a 30-day period. Sixty-six patients with left ventricular ejection fraction (LVEF) 40% and eGFR 15-89 mL/min/1.73 m 2 were randomized in a 1:1 ratio to receive a 24-h infusion with levosimendan or placebo. The B-type natriuretic peptide (BNP) and eGFR were determined at baseline and day 1, 3, 7, 14, 30 after the start of treatment. Results: The eGFR levels were obviously enhanced following levosimendan, peaked at 3 days, sustained for at least 14 days, and returned to baseline by day 30 after starting infusion. In contrast, placebo did not induce any significant changes in eGFR levels during the follow-up. In addition, levosimendan resulted in a distinct decrease in BNP levels in comparison with placebo, and the beneficial effect returned to baseline by day 14 and remained so at day 30 postinfusion. Conclusions: A 24-h infusion with levosimendan transiently improved the renal dysfunction compared with placebo in patients with DHF, and its beneficial effects persisted for at least 14 days after the initiation of treatment.

Levosimendan Versus Dobutamine in Myocardial Injury Patients with Septic Shock: A Randomized Controlled Trial

“…Several mechanisms probably account for the elevated BNP levels in sepsis, including neuro-hormonal activation, volume resuscitation, and sepsis-induced biventricular dilation [ 32 ], as well as stimulation of lipopolysaccharide or pro-inflammatory cytokines, acute lung injury, and acute respiratory distress syndrome induced sepsis [ 33 ]. Levosimendan was found to have significantly decreased BNP levels at Day 1 and Day 3 in patients with decompensated heart failure (DHF) and renal dysfunction [ 34 ]. Feola et al demonstrated that BNP concentrations decreased more significantly in a levosimendan group than a furosemide group [ 35 ].…”

Renal effects of vasodilators in acute heart failure

“…This understanding is exemplified by rolofylline-and the PRO-TECT hypothesis that improving renal blood flow and function could improve outcome in AHF-despite the neutral results of the PROTECT study [16]. Levosimendan has demonstrated renoprotective effects, albeit with inconclusive survival effects, further supporting the hypothesis that vasodilators can benefit renal function in AHF [84,91].…”

“…A number of studies have reported positive effects of Levosimendan treatment on renal function [81][82][83][84]. The explanation likely lies with levosimendan's vasodilator activity, with stronger venous compared to arterial vasodilation, along with its positive inotropic effects [85].…”

Impact of Levosimendan on Renal Function in Complex Treatment of Acute Decompensated Heart Failure

“…Hou и соавт. отмечали, что 24-часовая инфузия левосимендана по сравнению с плацебо увеличивала СКФ в течение 14 дней после инфузии у пациентов с ОДСН [27]. Также Zorlu и соавт.…”