Development of kidney function parameters in patients with advanced heart failure treated with levosimendan – retrospective analysis

Czech version

Authors: P. Doškář ¹; F. Málek ¹; J. Dvořák ²; P. Henyš ¹; P. Ošťádal ¹; A. Krüger ¹; D. Vondráková ¹; M. Janotka ¹; D. Říhová ¹; P. Neužil ¹
Authors‘ workplace: Kardiocentrum, Nemocnice Na Homolce, Praha ¹; Státní zdravotní ústav, Praha ²
Published in: Kardiol Rev Int Med 2014, 16(1): 31-33
Category: Cardiology Review

Overview

The aim of the study was to evaluate the change of renal function parameters during hospital stay in unselected acute decompensated severe HF population treated with levosimendan.

Patient population and methods:
The change of renal parameters was assessed in 91 consecutive patients, the mean LV EF was 23%, mean urea level was 12.12 mmol/ l, mean creatinine level was 147.1 mmol/ l and estimated glomerular filtration rate (eGFR) was 42.6 ml/ min/ 1.73m².

Results:
Mean interval between the first (V1) and the second (V2) biochemical evaluation was 11 days (± 7.8). Mean urea level decreased (from 12.12 to 11.37 mmol/ l, p = 0.27), as well as mean creatinine level decreased (from 147.1 to 142.5, p = 0.33), and mean eGFR increased (from 42.6 to 45.8 ml/ min/ 1.73m², p = 0.067) in the interval between V1 and V2. Urea and creatinine levels decreased in majority of the cases (not significant) and eGFR level significantly increased in majority of the cases (68% vs 32%, p < 0.001).

Conclusion:
Despite an insignificant change of urea and creatinine levels, the increase of eGFR was reported in majority of the cases.

Keywords:
advanced heart failure – decompensation – levosimendan – kidney function – glomerular filtration

Sources

1. Hillege HL, Girbes AR, de Kam PJ et al. Renal function, neurohormonal activation, and survival in patients with chronic heart failure. Circulation 2000; 102: 203– 210.

2. Delaney A, Bradford C, McCaffrey J et al. Levosimendan for the treatment of acute severe heart failure: a meta‑analysis of randomised controlled trials. Int J Cardiol. 2010; 138: 281– 289. doi: 10.1016/ j.ijcard.2008.08.020.

3. Zemljic G, Bunc M, Yazdanbakhsh AP, Vrtovec B. Levosimendan improves renal function in patients with advanced chronic heart failure awaiting cardiac transplantation. J Card Fail 2007; 13: 417– 421.

4. Yilmaz MB, Yalta K, Yontar C et al. Levosimendan improves renal function in patiens with acute decompensated heart failure: comparison with dobutamin. Cardiovasc Drugs Ther 2007; 21: 431– 435.

5. Follath F, Cleland JG, Just H et al. Efficacy and safety of intravenous levosimendan compared with dobutamine in severe low– output heart failure (the LIDO study): a randomised double‑blind trial. Lancet 2002; 360: 196– 202.

6. Schuck O, Teplan V, Marečková O et al. Estimation of glomerular filtration rate based on the modifikation of diet in renal disease equation in patients with chronic renal failure. Kidney Blood Press Res 2005; 28: 63– 67.

7. Endoh M. Mechanisms of action of novel cardiotonic agents. J Cardiovasc Pharmacol 2002; 40: 323– 338.

8. Kivikko M, Lehtonen L, Colucci WS et al. Sustained hemodynamic effects of intravenous levosimendan. Circulation 2003; 107: 81– 86.

9. Pagel P, Hettrick D, Warltier D. Influence of levosimendan, pimobendan and milrinone on the regional distribution of cardiac output in anaesthetized dogs. Br J Pharmacol 1996; 119: 609– 615.

10. Zager RA, Johnson AC, Lund S et al. Levosimendan protects against experimental endotoxemic acute renal failure. Am J Physiol Renal Physiol 2006; 290 : F1453– F1462.

11. Damman K, Navis G, Smilde TD et al. Decreased cardiac output, venous congestion and the association with renal impairment in patiens with cardiac dysfunction. Eur J Heart Fail 2007; 9: 872– 878.

12. Parissis JT, Adamopoulos S, Antoniades C et al. Effects of levosimendan on circulating pro‑inflammatory cytokines and soluble apoptosis mediators in patiens with decompensated advanced heart failure. Am J Cardiol 2004; 93: 1309– 1312.