Renal effects of levosimendan: a consensus report.
Renal dysfunction is common in clinical settings in which cardiac function is compromised such as heart failure, cardiac surgery or sepsis, and is associated with high morbidity and mortality. Levosimendan is a calcium sensitizer and potassium channel opener used in the treatment of acute heart failure. This review describes the effects of the inodilator levosimendan on renal function. A panel of 25 scientists and clinicians from 15 European countries (Austria, Finland, France, Hungary, Germany, Greece, Italy, Portugal, the Netherlands, Slovenia, Spain, Sweden, Turkey, the United Kingdom, and Ukraine) convened and reached a consensus on the current interpretation of the renal effects of levosimendan described both in non-clinical research and in clinical study reports. Most reports on the effect of levosimendan indicate an improvement of renal function in heart failure, sepsis and cardiac surgery settings. However, caution should be applied as study designs differed from randomized, controlled studies to uncontrolled ones. Importantly, in the largest HF study (REVIVE I and II) no significant changes in the renal function were detected. As it regards the mechanism of action, the opening of mitochondrial KATP channels by levosimendan is involved through a preconditioning effect. There is a strong rationale for randomized controlled trials seeking beneficial renal effects of levosimendan. As an example, a study is shortly to commence to assess the role of levosimendan for the prevention of acute organ dysfunction in sepsis (LeoPARDS).
Department of Cardiology, Cumhuriyet University School of Medicine, Sivas, Turkey, cardioceptor@gmail.com.
Mehmet B
MB
Yilmaz
Elena
E
Grossini
José C
JC
Silva Cardoso
István
I
Édes
Francesco
F
Fedele
Piero
P
Pollesello
Matti
M
Kivikko
Veli-Pekka
VP
Harjola
Julia
J
Hasslacher
Alexandre
A
Mebazaa
Andrea
A
Morelli
Jos
J
le Noble
Anders
A
Oldner
Ignacio
I
Oulego Erroz
John T
JT
Parissis
Alexander
A
Parkhomenko
Gerhard
G
Poelzl
Sebastian
S
Rehberg
Sven-Erik
SE
Ricksten
Luís M
LM
Rodríguez Fernández
Markku
M
Salmenperä
Mervyn
M
Singer
Sascha
S
Treskatsch
Bojan
B
Vrtovec
Gerhard
G
Wikström
D000818:Animals; D002316:Cardiotonic Agents / Q000494:pharmacology*; D006801:Humans; D006835:Hydrazones / Q000494:pharmacology*; D007668:Kidney / Q000187:drug effects* / Q000502:physiology; D011724:Pyridazines / Q000494:pharmacology*; D000077464:Simendan
D002316:Cardiotonic Agents; D006835:Hydrazones; D011724:Pyridazines; D000077464:Simendan