Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Expert Opin Drug Saf. 2021 Nov;20(11):1411-1420. doi: 10.1080/14740338.2021.1951700. Epub 2021 Jul 10.
Levosimendan, an inotrope, is widely used in the management of heart failure (HF) and cardiac surgery, but it remains uncertain whether levosimendan can improve renal function in patients with left ventricular dysfunction (LVD).
PubMed, Embase, and Cochrane CENTRAL from the inception to June 2020 were systematically screened for randomized controlled trials (RCTs) to investigate whether levosimendan offers kidney-related advantages in cardiovascular patients with LVD. We pooled the effects using a random-effect model.
Twenty-eight studies enrolling 5069 patients were included. Levosimendan reduced the sCr (SMD -0.28, 95% CI (-0.48, -0.09), P = 0.005, I = 52.5%, high quality) and the risk of ARF (relative risk 0.75, 95%CI (0.60, 0.95), P = 0.017, I = 11.3%, moderate-quality) in patients with LVD compared with control group. The reduction of sCr was more pronounced in patients with a relatively higher baseline sCr level. For secondary outcomes, levosimendan therapy was associated with the improvement of GFR (SMD 0.32, 95%CI (-0.05, 0.68), P = 0.092, I = 55.1%, low-quality) and urine output (SMD 0.42, 95%CI (0.06, 0.79), P = 0.024, I = 50.0%, very low-quality), but there was no significant reduction in BUN (SMD -0.14, 95%CI (-0.97, 0.70), P = 0.774, I = 77.9%, very low-quality).
Levosimendan might improve renal function of patients with LVD.
左西孟旦是一种正性肌力药物，广泛应用于心力衰竭（HF）和心脏手术的治疗，但它能否改善左心室功能障碍（LVD）患者的肾功能仍不确定。
系统检索 PubMed、Embase 和 Cochrane CENTRAL 数据库，从建库至 2020 年 6 月，收集左西孟旦治疗 LVD 患者的随机对照试验（RCT），采用随机效应模型进行荟萃分析。
共纳入 28 项研究，包括 5069 例患者。与对照组相比，左西孟旦降低了 LVD 患者的 sCr（SMD-0.28，95%CI[-0.48，-0.09]，P=0.005，I²=52.5%，高质量）和急性肾损伤（ARF）风险（相对风险 0.75，95%CI[0.60，0.95]，P=0.017，I²=11.3%，中质量）。sCr 基线水平较高的患者中，sCr 降低更为明显。对于次要结局，左西孟旦治疗与 GFR 的改善相关（SMD 0.32，95%CI[-0.05，0.68]，P=0.092，I²=55.1%，低质量）和尿量增加（SMD 0.42，95%CI[0.06，0.79]，P=0.024，I²=50.0%，极低质量），但 BUN 无明显降低（SMD-0.14，95%CI[-0.97，0.70]，P=0.774，I²=77.9%，极低质量）。
左西孟旦可能改善 LVD 患者的肾功能。
