1 Department of Anesthesiology and Intensive Care Medicine University of Gothenburg Sahlgrenska University Gothenburg Sweden.
3 Department of Transplantation Sahlgrenska University Hospital Gothenburg Sweden.
J Am Heart Assoc. 2018 Aug 21;7(16):e008455. doi: 10.1161/JAHA.117.008455.
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 m) 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.
晚期心力衰竭中心血管肾综合征的治疗颇具挑战性，且正性肌力药物的作用尚未完全明确。本研究旨在比较左西孟旦与多巴酚丁胺对心力衰竭合并肾功能不全患者的肾脏作用。
在一项随机、双盲研究中，我们将慢性心力衰竭（左心室射血分数<40%）合并肾功能不全（肾小球滤过率<80 ml/min/1.73 m 2 ）患者随机分为左西孟旦组（负荷剂量 12 μg/kg+0.1 μg/kg/min）或多巴酚丁胺组（7.5 μg/kg/min），输注 75 分钟。采用肺动脉漂浮导管测量全身血流动力学，肾静脉导管采用 PAH（对氨基马尿酸）输注清除技术测量肾血浆流量，通过 PAH 的肾摄取率校正。采用铬乙基二胺四乙酸肾摄取率测量滤过分数。共 32 例患者完成了研究。治疗后，左西孟旦组和多巴酚丁胺组的肾血流量分别增加 22%和 26%，两组间无显著差异。左西孟旦组肾小球滤过率增加 22%，而多巴酚丁胺组无变化（P=0.012）。左西孟旦对滤过分数无影响，而多巴酚丁胺则降低 17%（P=0.045）。
在慢性心力衰竭合并肾功能不全患者中，与多巴酚丁胺相比，左西孟旦可更大程度地增加肾小球滤过率，因此可能是治疗心血管肾综合征患者的首选正性肌力药物。
https://www.clinicaltrials.gov 。独特识别码：NCT 02133105。
