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Heart Lung Vessel. 2015;7(1):35-46.

Beneficial impact of levosimendan in critically ill patients with or at risk for acute renal failure: a meta-analysis of randomized clinical trials.

Author information

1
Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
2
Anesthesia and Intensive Care, A.O. Regionale "San Carlo", Potenza, Italy.
3
Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy ; Section of Medical Statistics and Biometry Giulio A. Maccacaro, Department of Occupational and Environmental Health, University of Milan, Milan, Italy.
4
Department of Cardiovascular Anesthesia and Cardiac Intensive Care Medicine, Clinic of Anesthesiology, Reanimatology and Intensive Care Medicine.
5
Dante Pazzanese Institute of Cardiology, São Paulo, Brazil.
6
Department of Anesthesiology and Intensive Care, State Research Institute of Circulation Pathology, Novosibirsk, Russia.

Abstract

INTRODUCTION:

The incidence of Acute Kidney Injury is nowadays high in critically ill patients. Its etiology is multifactorial and a primary role is played by low cardiac output syndrome. Everything targeted to normalize cardiac output should increase the renal perfusion and abolish the secondary vasoconstriction. Levosimendan is a calcium sensitizer drug with inotropic properties that improves cardiac output and seems to increase renal blood flow. The aim of this meta-analysis was to evaluate the role of levosimendan in critically ill patients with or at risk of Acute Kidney Injury.

METHODS:

We performed a meta-analysis of  randomized controlled trials searching for trials that compared levosimendan with any comparator. The endpoints were the number of patients receiving Renal Replacement Therapy after randomization and the number of patients developing Acute Kidney Injury.

RESULTS:

Final analysis included 33 trials and 3,879 patients (2,024 levosimendan and 1,855 control). The overall analysis showed that the use of levosimendan was associated with a significant reduction in the risk of Renal Replacement Therapy (17 of 492 [3.5%] in the levosimendan group versus 37 of 427 [8.7%] in the control group, relative risk =0.52 [0.32 to 0.86], p for effect =0.01) and of Acute Kidney Injury (114 of 1,598 [7.1%] in the levosimendan group versus 143 of 1,529 [9.4%] in the control arm, relative risk =0.79 [0.63 to 0.99], p for effect =0.048).

CONCLUSIONS:

This meta-analysis suggests that the use of levosimendan is associated with a significant reduction of Renal Replacement Therapy in critically ill patients.

KEYWORDS:

acute kidney injury; critical care; levosimendan; renal replacement therapy

PMID:
25861589
PMCID:
PMC4381821

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