Perioperative Levosimendan Therapy Is Associated With a Lower Incidence of Acute Kidney Injury After Cardiac Surgery

Niu, Zhaozhuo; Wu, Shanshan; Sun, Wenyu; Hou, Wen-ming; Chi, Yong

doi:10.1097/fjc.0000000000000028

Cited by 45 publications

(22 citation statements)

References 51 publications

(46 reference statements)

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“…This is consistent with previous findings in patients with decompensated heart failure [25]-[27] and also inline with a recently published meta analysis in the perioperative setting [28]. The aspect of timing of levosimendan administration has been addressed by Aksun et al [29] in a study involving 15 patients in total.…”

Section: Discussionsupporting

confidence: 91%

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

Balzer

Treskatsch

Spies

et al. 2014

J Cardiothorac Surg

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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.

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Section: Discussionsupporting

confidence: 91%

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

Balzer

Treskatsch

Spies

et al. 2014

J Cardiothorac Surg

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“…Moreover, the need for additional inotropic or mechanical therapy was decreased especially in patients with blunted ventricular function [ 87 – 90 ]. Furthermore, a meta-analysis which was of randomised studies including 529 patients in 5 trials suggested that Levosimendan might reduce renal injury in adult patients undergoing cardiac surgery [ 91 ].…”

Section: Intervention To Reduce Oxidative Stress During Cpbmentioning

confidence: 99%

Cardiopulmonary Bypass and Oxidative Stress

Zakkar

Guida

Suleiman

et al. 2015

Oxidative Medicine and Cellular Longevity

130

106

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The development of the cardiopulmonary bypass (CPB) revolutionized cardiac surgery and contributed immensely to improved patients outcomes. CPB is associated with the activation of different coagulation, proinflammatory, survival cascades and altered redox state. Haemolysis, ischaemia, and perfusion injury and neutrophils activation during CPB play a pivotal role in oxidative stress and the associated activation of proinflammatory and proapoptotic signalling pathways which can affect the function and recovery of multiple organs such as the myocardium, lungs, and kidneys and influence clinical outcomes. The administration of agents with antioxidant properties during surgery either intravenously or in the cardioplegia solution may reduce ROS burst and oxidative stress during CPB. Alternatively, the use of modified circuits such as minibypass can modify both proinflammatory responses and oxidative stress.

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“…On the basis of one of the retrospective meta-analyses, it was noticed that there were fewer complications of acute kidney injury after cardiac surgical procedures in groups that were given LSM, in comparison with the placebo, milrinone, and dobutamine groups [48].…”

Section: Levosimendan In Sepsismentioning

confidence: 99%

Levosimendan in the modern treatment of patients with acute heart failure of various aetiologies

et al. 2021

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Acute decompensated heart failure (ADHF) is a common clinical problem associated with a high mortality rate. Because ADHF has various aetiologies, there are a range of therapeutic options, among others, positive inotropes (inotropic drugs). As an inotropic agent whose mechanism is different than that of "classical" medicines, levosimendan (LSM) is one of the most common therapeutic options. Despite many publications on LSM, some issues related to its application remain unclear. The authors of this paper have attempted to summarise expert recommendations and reports available in the literature.

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Perioperative Levosimendan Therapy Is Associated With a Lower Incidence of Acute Kidney Injury After Cardiac Surgery

Abstract: This analysis suggests that levosimendan might reduce renal injury in adult patients undergoing cardiac surgery. More prospective randomized studies are needed to further demonstrate the benefits of levosimendan on renal protection in cardiac surgery.

Cited by 45 publications

References 51 publications

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

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

Cardiopulmonary Bypass and Oxidative Stress

Levosimendan in the modern treatment of patients with acute heart failure of various aetiologies

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