Effect of levosimendan in patients with severe systolic heart failure and worsening renal function.
BACKGROUND
Levosimendan, a calcium sensitizer, increases the sensitivity of the heart to calcium, thus increasing myocardial contractility without a rise in intracellular calcium. It was recently shown that levosimendan is beneficial in improving renal function. However, it remains to be established that the beneficial effect is differentially related to renal status during index event.


OBJECTIVE
The purpose of the current study was to determine whether levosimendan could improve renal outcome in acute decompensated heart failure patients with and without worsening renal function.


METHODS
Forty-five consecutive patients who had a reduced glomerular filtration rate and had at least two consecutive data regarding renal function prior to administration of levosimendan were enrolled in the study. Patients were classified into two groups as those with and without worsening renal function based on an increase in serum creatinine >0.3 mg/dL.


RESULTS
A significant improvement was noted in renal function in patients with worsening renal function (serum creatinine from 1.4 ± 0.16 to 1.21 ± 0.23 mg/dL, p=0.001 and glomerular filtration rate level from 48.9 ± 15 to 59.3 ± 21.8 mL/min/m², p=0.011), while there was no significant improvement in those without worsening renal function (serum creatinine from 1.29 ± 0.33 to 1.37 ± 0.66 mg/dL, p=0.240 and glomerular filtration rate level from 53.7 ± 17.6 to 52.9 ± 21.4 mL/min/m², p=0.850).


CONCLUSIONS
Levosimendan appears to provide a renal-enhancing effect in patients with severe, acute decompensated systolic heart failure and worsening renal function. Consideration of this differential effect might help obtain beneficial renal outcomes.
Department of Cardiology, Cumhuriyet University School of Medicine, Sivas, Turkey.
Ali
A
Zorlu
Hasan
H
Yücel
Osman Can
OC
Yontar
Oguz
O
Karahan
Izzet
I
Tandogan
Nurkay
N
Katrancioglu
Mehmet Birhan
MB
Yilmaz
D000368:Aged; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D003404:Creatinine / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D054143:Heart Failure, Systolic / Q000188:drug therapy*; D006801:Humans; D006835:Hydrazones / Q000627:therapeutic use*; D007668:Kidney / Q000187:drug effects* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011724:Pyridazines / Q000627:therapeutic use*; D051437:Renal Insufficiency / Q000188:drug therapy*; D012189:Retrospective Studies; D000077464:Simendan; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
D002316:Cardiotonic Agents; D006835:Hydrazones; D011724:Pyridazines; D000077464:Simendan; D003404:Creatinine