Incidence of Acute Renal Failure Associated with Milrinone

Abstract

Background: Milrinone is a phosphodiesterase type III inhibitor with positive inotropic and vasodilatory effects used in patients with severe congestive heart failure (CHF). Objectives:To determine the incidence rate of acute renal failure (ARF) associated with milrinone therapy.Methods: Medical records of 116 patients with cardiomyopathy/severe CHF who Twenty-nine patients were excluded, resulting in 87 patients, 4 of whom received milrinone twice.Results: During a 3-year period, 11 of 91 milrinone therapies became complicated with ARF (incidence 12%). The patients' age (mean ± SD) was 52.3 ± 13.6 years, baseline serum creatinine (SCr) was 1.6 ± 1.0 mg/dL, milrinone dose was 0.47 ± 0.16 µg/kg/min, and mean duration of therapy was 6.5 ± 10.6 days. Fourteen treatments were <24 hours, 2 (14%) of which were complicated with ARF; of the remaining 77 treatments (≥24 h), 9 (11.7%) were complicated with ARF. Their peak SCr was 3.2 ± 1.5 mg/dL and time to peak SCr was 4.9 ± 2.8 days. There was no significant difference in the incidence of ARF in patients who received therapy for <24 hours versus ≥24 hours; in the prevalence rate of diabetes mellitus, hypertension, coronary artery disease; or in baseline SCr, milrinone dose, and duration of therapy between patients who did and did not develop ARF. Conclusions:We found a 12% incidence of ARF in patients receiving milrinone therapy for severe CHF, which in the absence of an appropriate control group could be the aggregate effects of milrinone therapy and severe CHF.

The metabolic and renal effects of adrenaline and milrinone in patients with myocardial dysfunction after coronary artery bypass grafting

“…Moreover, preemptive therapy with PDE-III inhibitors has been shown to exert beneficial effects on markers of renal tubular injury in patients undergoing on-pump cardiac surgery [ 9 , 10 ]. In contrast, data derived from patients with decompensated heart failure suggest that the use of milrinone may be associated with a higher rate of renal dysfunction [ 11 ].…”

Milrinone in Advanced Heart Failure

“…Nevertheless, we demonstrated a relationship between milrinone dose and renal function, and the problems related to milrinone toxicity in renal failure have been reported in other studies. 35 In conclusion, plasma milrinone levels could be effectively monitored by the HPLC-MS method that provides rapid results and thus allows dose adjustment before toxicity can occur. Moreover, therapeutic plasma levels may often be achieved in patients with ACHF at infusion rates lower than recommended in the SPC.…”

“…Nevertheless, we demonstrated a relationship between milrinone dose and renal function, and the problems related to milrinone toxicity in renal failure have been reported in other studies. 35…”