Levosimendan for Prevention of Acute Kidney Injury After Cardiac Surgery: A Meta-analysis of Randomized Controlled Trials

Zhou, Chenghui; Gong, Junsong; Dong, Chen; Wang, Weipeng; Liu, Mingzheng; Liu, Bin

doi:10.1053/j.ajkd.2015.09.015

Cited by 81 publications

(48 citation statements)

References 48 publications

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“…The last meta-analysis of RCTs in the critically ill population with or at risk of AKI (33 RCTs, 3867 patients) found that, compared to placebo or another inotrope, levosimendan decreased the risk of AKI [RR 0.79 (0.63–0.99)] and the need for RRT [RR 0.52 (0.32–0.86)]. When limiting the analysis to high-quality studies, the difference in need for RRT between groups failed to reach significance [RR 0.41 (0.15–1.12)] [161]. Studies in both meta-analyses were small, there was some heterogeneity, AKI was not always a predefined endpoint, different definitions of AKI were used and there might have been some outcome reporting bias.…”

Section: Use Of Vasodilatorsmentioning

confidence: 99%

Prevention of acute kidney injury and protection of renal function in the intensive care unit: update 2017

et al. 2017

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BackgroundAcute kidney injury (AKI) in the intensive care unit is associated with significant mortality and morbidity.ObjectivesTo determine and update previous recommendations for the prevention of AKI, specifically the role of fluids, diuretics, inotropes, vasopressors/vasodilators, hormonal and nutritional interventions, sedatives, statins, remote ischaemic preconditioning and care bundles.MethodA systematic search of the literature was performed for studies published between 1966 and March 2017 using these potential protective strategies in adult patients at risk of AKI. The following clinical conditions were considered: major surgery, critical illness, sepsis, shock, exposure to potentially nephrotoxic drugs and radiocontrast. Clinical endpoints included incidence or grade of AKI, the need for renal replacement therapy and mortality. Studies were graded according to the international GRADE system.ResultsWe formulated 12 recommendations, 13 suggestions and seven best practice statements. The few strong recommendations with high-level evidence are mostly against the intervention in question (starches, low-dose dopamine, statins in cardiac surgery). Strong recommendations with lower-level evidence include controlled fluid resuscitation with crystalloids, avoiding fluid overload, titration of norepinephrine to a target MAP of 65–70 mmHg (unless chronic hypertension) and not using diuretics or levosimendan for kidney protection solely.ConclusionThe results of recent randomised controlled trials have allowed the formulation of new recommendations and/or increase the strength of previous recommendations. On the other hand, in many domains the available evidence remains insufficient, resulting from the limited quality of the clinical trials and the poor reporting of kidney outcomes.Electronic supplementary materialThe online version of this article (doi:10.1007/s00134-017-4832-y) contains supplementary material, which is available to authorized users.

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Section: Use Of Vasodilatorsmentioning

confidence: 99%

Prevention of acute kidney injury and protection of renal function in the intensive care unit: update 2017

et al. 2017

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“…Levosimendan has been suggested to have renoprotective properties in several settings, such as cardiac surgery,7 heart transplantation,8 sepsis,9 and HF. The LIDO (Levosimendan Infusion versus Dobutamine) Study, which examined inotropic treatment among those with low‐output HF, showed that levosimendan brought about a significant decrease in serum creatinine compared with dobutamine 10.…”

mentioning

confidence: 99%

Differential Effects of Levosimendan and Dobutamine on Glomerular Filtration Rate in Patients With Heart Failure and Renal Impairment:A Randomized Double‐Blind Controlled Trial

Lannemyr

Ricksten

Rundqvist

et al. 2018

JAHA

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BackgroundThe management of the cardiorenal syndrome in advanced heart failure is challenging, and the role of inotropic drugs has not been fully defined. Our aim was to compare the renal effects of levosimendan versus dobutamine in patients with heart failure and renal impairment.Methods and ResultsIn a randomized double‐blind study, we assigned patients with chronic heart failure (left ventricular ejection fraction <40%) and impaired renal function (glomerular filtration rate <80 mL/min per 1.73 m2) to receive either levosimendan (loading dose 12 μg/kg+0.1 μg/kg per minute) or dobutamine (7.5 μg/kg per minute) for 75 minutes. A pulmonary artery catheter was used for measurements of systemic hemodynamics, and a renal vein catheter was used to measure renal plasma flow by the infusion clearance technique for PAH (para‐aminohippurate) corrected by renal extraction of PAH. Filtration fraction was measured by renal extraction of chromium ethylenediamine tetraacetic acid. A total of 32 patients completed the study. Following treatment, the levosimendan and dobutamine groups displayed similar increases in renal blood flow (22% and 26%, respectively) with no significant differences between groups. Glomerular filtration rate increased by 22% in the levosimendan group but remained unchanged in the dobutamine group (P=0.012). Filtration fraction was not affected by levosimendan but decreased by 17% with dobutamine (P=0.045).ConclusionsIn patients with chronic heart failure and renal impairment, levosimendan increases glomerular filtration rate to a greater extent than dobutamine and thus may be the preferred inotropic agent for treating patients with the cardiorenal syndrome.Clinical Trial RegistrationURL: https://www.clinicaltrials.gov. Unique identifier: NCT02133105.

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“…Die Verwendung eines erweiterten hämodynamischen Monitorings ist mit gewissen Risiken verbunden, aber der Einsatz sicherlich bei Hochrisikopatienten gerechtfertigt [48]. In den letzten Jahren wurde in zahlreichen Studien gezeigt, dass der Einsatz von Statinen [34], Natriumbikarbonat [28], N-Acetylcystein [10,25], Erythropoietin [59], Dopamin [42], Schleifendiuretika [42,47] und Levosimendan [86] bei herzchirurgischen Patienten nicht zu einer Senkung der AKIRate führt und somit nicht indiziert ist.…”

Section: Kardiochirurgische Patientenunclassified

Prävention der akuten Nierenschädigung beim kritisch kranken Patienten

Joannidis

Klein

John

et al. 2018

Med Klin Intensivmed Notfmed

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Die akute Nierenschädigung ("acute kidney injury", AKI) ist ein komplexes Krankheitsbild, das durchschnittlich 50 % der Patienten auf Intensivstationen weltweit betrifft und mit erhöhter Morbidität und Mortalität einhergeht [32,36]. Das Spektrum der AKI reicht von einer Schädigung der Niere ohne Funktionsverlust bis zum Versagen des Organs mit der Notwendigkeit einer Nierenersatztherapie.Über die letzten Jahre wurden Diagnosekriterien für die AKI entwickelt. Die aktuellsten stellen die KDIGO-Leitlinien (KDIGO: "Kidney Disease: Improving Global Outcomes") aus dem Jahr 2012 dar, in denen auch die Klassifikation der AKI geregelt wird.

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Levosimendan for Prevention of Acute Kidney Injury After Cardiac Surgery: A Meta-analysis of Randomized Controlled Trials

Cited by 81 publications

References 48 publications

Prevention of acute kidney injury and protection of renal function in the intensive care unit: update 2017

Prevention of acute kidney injury and protection of renal function in the intensive care unit: update 2017

Differential Effects of Levosimendan and Dobutamine on Glomerular Filtration Rate in Patients With Heart Failure and Renal Impairment:A Randomized Double‐Blind Controlled Trial

Prävention der akuten Nierenschädigung beim kritisch kranken Patienten

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