The effects of levosimendan on renal function early after heart transplantation: results from a pilot randomized trial

Kneževič, Ivan; Poglajen, Gregor; Hrovat, Eva; Oman, A.; Pintar, Tatjana; Wu, Joseph C.; Vrtovec, Bojan; Haddad, François

doi:10.1111/ctr.12424

Cited by 27 publications

(19 citation statements)

References 34 publications

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“…Reported risk factors for AKI in patients undergoing cardiac transplantation are shown in Table 3. Preoperative risk factors including chronic kidney disease (CKD) [8,19,36,43,51], diabetes mellitus (DM) [36,43], and older age [19,41,52]. were consistently demonstrated as associated risk factors for AKI in patients after cardiac transplantation.…”

Section: Discussionmentioning

confidence: 99%

Acute Kidney Injury in Patients Undergoing Cardiac Transplantation: A Meta-Analysis

et al. 2019

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Background: Acute kidney injury (AKI) is a common complication following solid-organ transplantation. However, the epidemiology of AKI and mortality risk of AKI among patients undergoing cardiac transplantation is not uniformly described. We conducted this study to assess the incidence of AKI and mortality risk of AKI in adult patients after cardiac transplantation. Methods: A systematic review of EMBASE, MEDLINE, and Cochrane Databases was performed until June 2019 to identify studies evaluating the incidence of AKI (by standard AKI definitions), AKI requiring renal replacement therapy (RRT), and mortality risk of AKI in patients undergoing cardiac transplantation. Pooled AKI incidence and mortality risk from the included studies were consolidated by random-effects model. The protocol for this study is registered with PROSPERO (no. CRD42019134577). Results: 27 cohort studies with 137,201 patients undergoing cardiac transplantation were identified. Pooled estimated incidence of AKI and AKI requiring RRT was 47.1% (95% CI: 37.6–56.7%) and 11.8% (95% CI: 7.2–18.8%), respectively. The pooled ORs of hospital mortality and/or 90-day mortality among patients undergoing cardiac transplantation with AKI and AKI requiring RRT were 3.46 (95% CI, 2.40–4.97) and 13.05 (95% CI, 6.89–24.70), respectively. The pooled ORs of 1-year mortality among patients with AKI and AKI requiring RRT were 2.26 (95% CI, 1.56–3.26) and 3.89 (95% CI, 2.49–6.08), respectively. Conclusion: Among patients undergoing cardiac transplantation, the incidence of AKI and severe AKI requiring RRT are 47.1% and 11.8%, respectively. AKI post cardiac transplantation is associated with reduced short term and 1-year patient survival.

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Section: Discussionmentioning

confidence: 99%

Acute Kidney Injury in Patients Undergoing Cardiac Transplantation: A Meta-Analysis

et al. 2019

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“…Beneficial effects of levosimendan on heart failure-related renal dysfunction have been recorded in several small studies [63][64][65][66]. Of note in the context of levosimendan therapy as a 'bridge' to successful heart transplantation, early postoperative use of levosimendan has been reported to improve renal function in transplant recipients [67].…”

Section: Effect On Kidney Function In Progressing Heart Failurementioning

confidence: 99%

Advanced heart failure: an appraisal of the potential of levosimendan in this end-stage scenario and some related ethical considerations

Fruhwald

Pollesello

Fruhwald

2016

Expert Review of Cardiovascular Therapy

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The later stages of heart failure are characterized by a steady decline in quality of life. Clinical priorities should be to maintain functional capacity and quality of life. In the absence of sufficient organs for transplantation, options include left ventricular assist devices and inotropic support. Areas covered: We examined data published in the last two decades on the use of inotropes and inodilators in advanced heart failure. Expert commentary: In the literature, use of conventional inotropes, including adrenergic agonists and phosphodiesterase inhibitors, appears to be suboptimal for achieving the clinical priorities of late-stage heart failure. Evidence suggests instead that the calcium-sensitizing inodilator levosimendan, administered intermittently, delivers improvements in functional capacity and quality of life and does so with no adverse impact on life expectancy. At a terminal or near-terminal stage of heart failure, the therapeutic philosophy should shift towards meeting patients' existential priorities rather than traditional heart failure-centric targets.

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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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The effects of levosimendan on renal function early after heart transplantation: results from a pilot randomized trial

Abstract: In patients undergoing heart transplantation, levosimendan-based strategy may be associated with better renal function when compared to standard therapy.

Cited by 27 publications

References 34 publications

Acute Kidney Injury in Patients Undergoing Cardiac Transplantation: A Meta-Analysis

Acute Kidney Injury in Patients Undergoing Cardiac Transplantation: A Meta-Analysis

Advanced heart failure: an appraisal of the potential of levosimendan in this end-stage scenario and some related ethical considerations

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

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