title: Levosimendan for Prevention of Acute Kidney Injury After Cardiac Surgery: A Meta-analysis of Randomized Controlled Trials.
abstract: BACKGROUND
  Levosimendan has been shown to confer direct renoprotection in renal endotoxemic and ischemia-reperfusion injury and could increase renal blood flow in patients with low-cardiac-output heart failure. Results from clinical trials of levosimendan on acute kidney injury (AKI) following cardiac surgery are controversial.
  
  
  METHODS
  A random-effect meta-analysis was conducted based on evidence from PubMed, EMBASE, and Cochrane Library.
  
  
  METHODS
  Adult patients undergoing cardiac surgery.
  
  
  METHODS
  Randomized controlled trials comparing the renal effect of levosimendan versus placebo or other inotropic drugs during cardiac surgery.
  
  
  METHODS
  Perioperative levosimendan continuous infusion at a rate of 0.1 to 0.2μg/kg/min following a loading dose (6-24μg/kg) for 24 hours or only 1 loading dose (24μg/kg) within 1 hour.
  
  
  RESULTS
  AKI, need for renal replacement therapy, mechanical ventilation duration, intensive care unit stay during hospitalization, and postoperative mortality (in-hospital or within 30 days).
  
  
  RESULTS
  13 trials with a total of 1,345 study patients were selected. Compared with controls, levosimendan reduced the incidence of postoperative AKI (40/460 vs 78/499; OR, 0.51; 95% CI, 0.34-0.76; P=0.001; I(2)=0.0%), renal replacement therapy (22/492 vs 49/491; OR, 0.43; 95% CI, 0.25-0.76; P=0.002; I(2)=0.0%), postoperative mortality (35/658 vs 94/657; OR, 0.41; 95% CI, 0.27-0.62; P<0.001; I(2)=0.0%), mechanical ventilation duration (in days; n=235; weighted mean difference, -0.34; 95% CI, -0.58 to -0.09; P=0.007], and intensive care unit stay (in days; n=500; weighted mean difference, -2.2; 95% CI, -4.21 to -0.13; P=0.04).
  
  
  CONCLUSIONS
  Different definitions for AKI among studies. Small sample size for some trials.
  
  
  CONCLUSIONS
  Perioperative administration of levosimendan in patients undergoing cardiac surgery may reduce complications. Future trials are needed to determine the dose effect of levosimendan in improving outcomes, especially in patients with decreased baseline kidney function.
authors.affiliation: Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
authors.forename: Chenghui
authors.initials: C
authors.lastname: Zhou
authors.affiliation: Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
authors.forename: Junsong
authors.initials: J
authors.lastname: Gong
authors.affiliation: Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
authors.forename: Dong
authors.initials: D
authors.lastname: Chen
authors.affiliation: Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
authors.forename: Weipeng
authors.initials: W
authors.lastname: Wang
authors.affiliation: Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
authors.forename: Mingzheng
authors.initials: M
authors.lastname: Liu
authors.affiliation: Department of Anesthesiology, Laboratory of Anesthesia & Critical Care Medicine, Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, China. Electronic address: liubin_hx@126.com.
authors.forename: Bin
authors.initials: B
authors.lastname: Liu
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology / Q000517:prevention & control; D000328:Adult; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D006835:Hydrazones / Q000494:pharmacology*; D007668:Kidney / Q000187:drug effects*; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000517:prevention & control*; D020011:Protective Agents / Q000494:pharmacology; D011724:Pyridazines / Q000494:pharmacology*; D016032:Randomized Controlled Trials as Topic; D000077464:Simendan; D014665:Vasodilator Agents / Q000494:pharmacology
chemical_list: D006835:Hydrazones; D020011:Protective Agents; D011724:Pyridazines; D014665:Vasodilator Agents; D000077464:Simendan
keywords: Levosimendan; acute kidney injury (AKI); calcium sensitizer; cardiac surgery; heart surgery; inotropic drug; ischemia/reperfusion injury; meta-analysis; postoperative mortality; renal blood flow; renal replacement therapy (RRT); renoprotection