Preservation of renal function in cardiac surgery patients with low cardiac output syndrome: levosimendan vs beta agonists

Jose Luis Guerrero Orriach,M Rubio Navarro,J Cruz Mañas,A Ramirez Fernandez,I Navarro Arce,R Barrera Serrano,M Ramirez Aliaga,I Bellido Estevez,J J Escalona Belmonte,A Malo Manso,P Hernandez Rodriguez,A Raigón Ponferrada,C S Toledo Medina,A Gomez Luque

doi:10.1186/s12871-019-0888-2

Abstract

BackgroundSome studies have been performed to assess the effects of levosimendan on cardiac function when administered to cardiac surgery patients with low cardiac output syndrome (LCOS) in the immediate postoperative period. Levosimendan is an inotropic agent for the treatment of low cardiac output syndrome that seems to have a protective effect on renal function.MethodsIt is a quasi-experimental study. A total of 100 patients with LCOS received either beta-agonists or levosimendan. We assessed the incidence of postoperative kidney failure in cardiac surgery patients. In patients who had kidney failure at diagnosis of LCOS, we examined whether differences existed in the evolution of kidney failure based on the treatment administered for LCOS. The parameters measured included haemodynamics, oxygen supply, and renal function as assessed by the AKI scale. ANOVA, Student’s t-test and Wilcoxon or Friedman tests were used.ResultsUp to 30% of cardiac surgery patients had kidney failure at diagnosis of LCOS. Kidney failure at discharge from the ICU was more frequent in patients who received beta-agonist drugs as compared to those who received levosimendan (p < 0.05).ConclusionThe incidence of kidney failure decreased with the postoperative administration of levosimendan to cardiac surgery patients with LCOS, as compared to beta-agonists.Trial registrationCurrent Controlled Trials ISRCTN 46058317. Date of registration: 7/10/2019.Retrospectively registered.

Highlights

Some studies have been performed to assess the effects of levosimendan on cardiac function when administered to cardiac surgery patients with low cardiac output syndrome (LCOS) in the immediate postoperative period
In our study we finished the recruitment when 100 patients had a diagnosis of low cardiac output syndrome, these patients had an incidence of kidney failure at diagnosis of 30%
Kidney failure persisted at discharge only in some patients in the beta-agonist group, with significant differences between the two treatment groups (p < 0.05)

Summary

Introduction

Some studies have been performed to assess the effects of levosimendan on cardiac function when administered to cardiac surgery patients with low cardiac output syndrome (LCOS) in the immediate postoperative period. Levosimendan is an inotropic agent for the treatment of low cardiac output syndrome that seems to have a protective effect on renal function. One of the most common and serious complications of cardiac surgery is the low cardiac output syndrome (LCOS), which incidence in cardiac surgery patients ranges from 15 to 25%. This syndrome is associated with a mortality of 15%, reaching 70% in patients who develop cardiogenic shock. Kidney failure is reversible, patients who develop it have a higher risk of death than those who do not present this complication [3]

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