title: Beneficial impact of levosimendan in critically ill patients with or at risk for acute renal failure: a meta-analysis of randomized clinical trials.
abstract: BACKGROUND
  The incidence of Acute Kidney Injury is nowadays high in critically ill patients. Its etiology is multifactorial and a primary role is played by low cardiac output syndrome. Everything targeted to normalize cardiac output should increase the renal perfusion and abolish the secondary vasoconstriction. Levosimendan is a calcium sensitizer drug with inotropic properties that improves cardiac output and seems to increase renal blood flow. The aim of this meta-analysis was to evaluate the role of levosimendan in critically ill patients with or at risk of Acute Kidney Injury.
  
  
  METHODS
  We performed a meta-analysis of  randomized controlled trials searching for trials that compared levosimendan with any comparator. The endpoints were the number of patients receiving Renal Replacement Therapy after randomization and the number of patients developing Acute Kidney Injury.
  
  
  RESULTS
  Final analysis included 33 trials and 3,879 patients (2,024 levosimendan and 1,855 control). The overall analysis showed that the use of levosimendan was associated with a significant reduction in the risk of Renal Replacement Therapy (17 of 492 [3.5%] in the levosimendan group versus 37 of 427 [8.7%] in the control group, relative risk =0.52 [0.32 to 0.86], p for effect =0.01) and of Acute Kidney Injury (114 of 1,598 [7.1%] in the levosimendan group versus 143 of 1,529 [9.4%] in the control arm, relative risk =0.79 [0.63 to 0.99], p for effect =0.048).
  
  
  CONCLUSIONS
  This meta-analysis suggests that the use of levosimendan is associated with a significant reduction of Renal Replacement Therapy in critically ill patients.
authors: Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
authors: Tiziana
authors: T
authors: Bove
authors: Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
authors: Andrea
authors: A
authors: Matteazzi
authors: Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
authors: Alessandro
authors: A
authors: Belletti
authors: Anesthesia and Intensive Care, A.O. Regionale "San Carlo", Potenza, Italy.
authors: Gianluca
authors: G
authors: Paternoster
authors: Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
authors: Omar
authors: O
authors: Saleh
authors: Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
authors: Daiana
authors: D
authors: Taddeo
authors: Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
authors: Roberto
authors: R
authors: Dossi
authors: Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy ; Section of Medical Statistics and Biometry Giulio A. Maccacaro, Department of Occupational and Environmental Health, University of Milan, Milan, Italy.
authors: Teresa
authors: T
authors: Greco
authors: Department of Cardiovascular Anesthesia and Cardiac Intensive Care Medicine, Clinic of Anesthesiology, Reanimatology and Intensive Care Medicine.
authors: Nikola
authors: N
authors: Bradic
authors: Department of Cardiovascular Anesthesia and Cardiac Intensive Care Medicine, Clinic of Anesthesiology, Reanimatology and Intensive Care Medicine.
authors: Ino
authors: I
authors: Husedzinovic
authors: Dante Pazzanese Institute of Cardiology, São Paulo, Brazil.
authors: Caetano
authors: C
authors: Nigro Neto
authors: Department of Anesthesiology and Intensive Care, State Research Institute of Circulation Pathology, Novosibirsk, Russia.
authors: Vladimir V
authors: VV
authors: Lomivorotov
authors: Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
authors: Maria Grazia
authors: MG
authors: Calabrò
keywords: acute kidney injury; critical care; levosimendan; renal replacement therapy