Effect of levosimendan on renal function in background of left ventricular dysfunction: a meta-analysis of randomized trials

ABSTRACT

Objective

Levosimendan, an inotrope, is widely used in the management of heart failure (HF) and cardiac surgery, but it remains uncertain whether levosimendan can improve renal function in patients with left ventricular dysfunction (LVD).

Methods

PubMed, Embase, and Cochrane CENTRAL from the inception to June 2020 were systematically screened for randomized controlled trials (RCTs) to investigate whether levosimendan offers kidney-related advantages in cardiovascular patients with LVD. We pooled the effects using a random-effect model.

Results

Twenty-eight studies enrolling 5069 patients were included. Levosimendan reduced the sCr (SMD −0.28, 95% CI (−0.48, −0.09), P = 0.005, I² = 52.5%, high quality) and the risk of ARF (relative risk 0.75, 95%CI (0.60, 0.95), P = 0.017, I² = 11.3%, moderate-quality) in patients with LVD compared with control group. The reduction of sCr was more pronounced in patients with a relatively higher baseline sCr level. For secondary outcomes, levosimendan therapy was associated with the improvement of GFR (SMD 0.32, 95%CI (−0.05, 0.68), P = 0.092, I² = 55.1%, low-quality) and urine output (SMD 0.42, 95%CI (0.06, 0.79), P = 0.024, I² = 50.0%, very low-quality), but there was no significant reduction in BUN (SMD −0.14, 95%CI (−0.97, 0.70), P = 0.774, I² = 77.9%, very low-quality).

Conclusions

Levosimendan might improve renal function of patients with LVD.

KEYWORDS:

• Levosimendan
• left ventricular dysfunction
• serum creatinine
• acute renal failure
• meta-analysis

Authors’ contributions

Conceptualization: Yuxiang Long and Diyu Cui; search and search screening: Yuxiang Long, Diyu Cui and Xue Kuang; data extraction, data validation and quality assessment: Yuxiang Long, Diyu Cui and Yue Hu; statistical analysis and interpreted the results: Yuxiang Long, Diyu Cui, Xue Kuang and Shuang Hu; writing original draft preparation, Yuxiang Long and Diyu Cui; writing review and editing, Yuxiang Long and Diyu Cui; all authors have read and approved the final version.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/14740338.2021.1951700.

Additional information

Funding

This paper was not funded.