Early administration of levosimendan is associated with improved kidney function after cardiac surgery – a retrospective analysis

Abstract

BackgroundSeveral animal studies suggest beneficial effects on kidney function upon administration of levosimendan. As recent data from clinical studies are heterogeneous, we sought to investigate whether levosimendan is associated with improved postoperative kidney function in cardiac surgery patients with respect to timing of its administration.MethodsRetrospective, single centre, observational analysis at a university hospital in Berlin, Germany. All adult patients without preoperative renal dysfunction that underwent coronary artery bypass grafting and/or valve reconstruction/replacement between 01/01/2007 and 31/12/2011 were considered for analyses.ResultsOut of 1.095 included patients, 46 patients were treated with levosimendan due to a severely reduced left ventricular systolic function preoperatively (LVEF < 35%) and/or clinical signs of a low cardiac output syndrome. Sixty-one percent received the drug whilst in the OR, 39% after postoperative intensive care unit admission. When levosimendan was given immediately after anaesthesia induction, creatinine plasma levels (p = 0.009 for nonparametric analysis of longitudinal data in a two-factorial design) and incidence of postoperative renal dysfunction (67.9% vs. 94.4%; p = 0.033) were significantly reduced in contrast to a later start of treatment. In addition, duration of renal replacement therapy was significantly shorter (79 [35;332] vs. 272 [132;703] minutes; p = 0.046) in that group.ConclusionsPostoperative kidney dysfunction is a common condition in patients under going cardiac surgery. Patients with severely reduced left ventricular function and/or clinical signs of a low cardiac output syndrome who preoperatively presented with a normal kidney function may benefit from an early start of levosimendan administration, i.e. immediately after anaesthesia.Trial registrationClinicaltrials.gov-ID: NCT01918618.Electronic supplementary materialThe online version of this article (doi:10.1186/s13019-014-0167-8) contains supplementary material, which is available to authorized users.

Use of Levosimendan in Cardiac Surgery: An Update After the LEVO-CTS, CHEETAH, and LICORN Trials in the Light of Clinical Practice

“… 17 Indications of renal-protective effects in this setting have also been reported in retrospective analyses. 18 , 19 …”

Cost-benefits of incorporating levosimendan into cardiac surgery practice: German base case

“…The clinical benefits of using levosimendan in cardiac surgery have been demonstrated in a number of studies [1,17,[36][37][38][39][40]. In the current economic analysis, which evaluated the costs of levosimendan compared with dobutamine in patients requiring inotropic support following cardiac surgery in Germany, levosimendan was found to be cost saving from the hospital and health insurance perspectives.…”

Preservation of renal function in cardiac surgery patients with low cardiac output syndrome: levosimendan vs beta agonists

“…Balzer et al conducted a retrospective study in 46 patients who underwent coronary artery bypass grafting with creatinine < 2 mg/dl and a left ventricular systolic function < 35% and/or LOCS. The incidence of acute kidney failure was significantly lower in patients who received early levosimendan therapy vs. those who received late-start levosimendan therapy [13]. Treskatsch et al performed a study in 159 cardiac surgery patients with FEVI < 35% and/or LCOS, who were divided into two groups based on the timing of levosimendan administration.…”