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American Journal of Kidney Diseases

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

  • Chenghui Zhou
    Affiliations
    Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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  • Junsong Gong
    Affiliations
    Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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  • Dong Chen
    Affiliations
    Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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  • Author Footnotes
    ∗ WW, ML, and BL contributed equally to this work.
    Weipeng Wang
    Footnotes
    ∗ WW, ML, and BL contributed equally to this work.
    Affiliations
    Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
    Search for articles by this author
  • Author Footnotes
    ∗ WW, ML, and BL contributed equally to this work.
    Mingzheng Liu
    Footnotes
    ∗ WW, ML, and BL contributed equally to this work.
    Affiliations
    Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
    Search for articles by this author
  • Author Footnotes
    ∗ WW, ML, and BL contributed equally to this work.
    Bin Liu
    Correspondence
    Address correspondence to Bin Liu, MD, PhD, No. 17 Renmin South Road Third Section, 610041 Wuhou District, Chengdu, China.
    Footnotes
    ∗ WW, ML, and BL contributed equally to this work.
    Affiliations
    Department of Anesthesiology, Laboratory of Anesthesia & Critical Care Medicine, Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, China
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  • Author Footnotes
    ∗ WW, ML, and BL contributed equally to this work.
Published:October 27, 2015DOI:https://doi.org/10.1053/j.ajkd.2015.09.015

      Background

      Levosimendan has been shown to confer direct renoprotection in renal endotoxemic and ischemia-reperfusion injury and could increase renal blood flow in patients with low-cardiac-output heart failure. Results from clinical trials of levosimendan on acute kidney injury (AKI) following cardiac surgery are controversial.

      Study Design

      A random-effect meta-analysis was conducted based on evidence from PubMed, EMBASE, and Cochrane Library.

      Settings & Population

      Adult patients undergoing cardiac surgery.

      Selection Criteria for Studies

      Randomized controlled trials comparing the renal effect of levosimendan versus placebo or other inotropic drugs during cardiac surgery.

      Intervention

      Perioperative levosimendan continuous infusion at a rate of 0.1 to 0.2 μg/kg/min following a loading dose (6-24 μg/kg) for 24 hours or only 1 loading dose (24 μg/kg) within 1 hour.

      Outcomes

      AKI, need for renal replacement therapy, mechanical ventilation duration, intensive care unit stay during hospitalization, and postoperative mortality (in-hospital or within 30 days).

      Results

      13 trials with a total of 1,345 study patients were selected. Compared with controls, levosimendan reduced the incidence of postoperative AKI (40/460 vs 78/499; OR, 0.51; 95% CI, 0.34-0.76; P = 0.001; I2 = 0.0%), renal replacement therapy (22/492 vs 49/491; OR, 0.43; 95% CI, 0.25-0.76; P = 0.002; I2 = 0.0%), postoperative mortality (35/658 vs 94/657; OR, 0.41; 95% CI, 0.27-0.62; P < 0.001; I2 = 0.0%), mechanical ventilation duration (in days; n = 235; weighted mean difference, −0.34; 95% CI, −0.58 to −0.09; P = 0.007], and intensive care unit stay (in days; n = 500; weighted mean difference, −2.2; 95% CI, −4.21 to −0.13; P = 0.04).

      Limitations

      Different definitions for AKI among studies. Small sample size for some trials.

      Conclusions

      Perioperative administration of levosimendan in patients undergoing cardiac surgery may reduce complications. Future trials are needed to determine the dose effect of levosimendan in improving outcomes, especially in patients with decreased baseline kidney function.

      Index Words

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