Comparison between Levosimendan versus Beta Agonists in Preservation of Renal Function in Cardiac Surgery Patients with Low Cardiac Output Syndrome

Abstract

Abstract Background Acute kidney injury post cardiac surgery in patients who develop low cardiac output syndrome (LCOS) postoperatively is a serious complication. Many studies have been performed to assess the effect of inotropic agents on cardiac function when administered postoperatively, some studies performed to evaluate the nephroprotective effect of conventional inotropic agents as compared to levosimendan. Objective To evaluate the possible nephroprotective effect of Levosimendan as compared to betaagonists in cardiac surgery patients with LCOS. Patients and Methods It is a randomized prospective comparative study at Ain Shams university hospitals from December 2020 to May 2021. A total of 60 patients who have developed low cardiac output syndrome post cardiac surgery divided into two groups of 30 patients each. Group A received beta-agonists (dobutamine 2 - 20 µ/kg/min or adrenaline 0.01 to 0.5 mcg/kg/minute) and Group B received levosimendan for 24 h at a rate of 0.1 mcg/kg/min to a target dose of 12.5 mg. we assessed the incidence of renal failure in these patients. We assessed the progress of acute kidney injury in patients who developed acute renal impairment at diagnosis of LCOS in both treatment groups. Parameters assessed include hemodynamics and renal function parameters. Results The incidence of acute kidney injury at diagnosis of LCOS postoperative was 30% (n = 9) in each group, 44% of them in the control group (n = 4) developed renal failure at discharge from ICU and none of the study group patients developed renal failure at discharge. At time of discharge from ICU the incidence of renal failure in beta – agonist group was 13.3% while the incidence in the levosimendan group was 0%. Conclusion Levosimendan has a nephroprotective effect that plays a role in preservation of renal functions and decreasing the incidence of kidney failure in patients with LCOS post cardiac surgery as compared to beta – agonists.