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Differential Effects of Levosimendan and Dobutamine on Glomerular Filtration Rate in Patients With Heart Failure and Renal Impairment:A Randomized Double-Blind Controlled Trial.

Journal article
Authors Lukas Lannemyr
Sven-Erik Ricksten
Bengt Rundqvist
Bert Andersson
Sven-Erik Bartfay
Charlotta Ljungman
Pia Dahlberg
Niklas Bergh
Clara Hjalmarsson
Thomas Gilljam
Entela Bollano
Kristjan Karason
Published in Journal of the American Heart Association
Volume 7
Issue 16
Pages e008455
ISSN 2047-9980
Publication year 2018
Published at Institute of Clinical Sciences, Department of Anesthesiology and Intensive care
Institute of Medicine, Department of Molecular and Clinical Medicine
Pages e008455
Language en
Links dx.doi.org/10.1161/JAHA.117.008455
www.ncbi.nlm.nih.gov/entrez/query.f...
Subject categories Kidney diseases, Cardiovascular medicine

Abstract

Background The management of the cardiorenal syndrome in advanced heart failure is challenging, and the role of inotropic drugs has not been fully defined. Our aim was to compare the renal effects of levosimendan versus dobutamine in patients with heart failure and renal impairment. Methods and Results In a randomized double-blind study, we assigned patients with chronic heart failure (left ventricular ejection fraction <40%) and impaired renal function (glomerular filtration rate <80 mL/min per 1.73 m2) to receive either levosimendan (loading dose 12 μg/kg+0.1 μg/kg per minute) or dobutamine (7.5  μg/kg per minute) for 75 minutes. A pulmonary artery catheter was used for measurements of systemic hemodynamics, and a renal vein catheter was used to measure renal plasma flow by the infusion clearance technique for PAH (para-aminohippurate) corrected by renal extraction of PAH . Filtration fraction was measured by renal extraction of chromium ethylenediamine tetraacetic acid. A total of 32 patients completed the study. Following treatment, the levosimendan and dobutamine groups displayed similar increases in renal blood flow (22% and 26%, respectively) with no significant differences between groups. Glomerular filtration rate increased by 22% in the levosimendan group but remained unchanged in the dobutamine group ( P=0.012). Filtration fraction was not affected by levosimendan but decreased by 17% with dobutamine ( P=0.045). Conclusions In patients with chronic heart failure and renal impairment, levosimendan increases glomerular filtration rate to a greater extent than dobutamine and thus may be the preferred inotropic agent for treating patients with the cardiorenal syndrome. Clinical Trial Registration URL: https://www.clinicaltrials.gov . Unique identifier: NCT 02133105.

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