Effect of Levosimendan in Patients with Severe Systolic Heart Failure and Worsening Renal Function

Background: Levosimendan, a calcium sensitizer, increases the sensitivity of the heart to calcium, thus increasing myocardial contractility without a rise in intracellular calcium. It was recently shown that levosimendan is beneficial in improving renal function. However, it remains to be established that the beneficial effect is differentially related to renal status during index event. Objective: The purpose of the current study was to determine whether levosimendan could improve renal outcome in acute decompensated heart failure patients with and without worsening renal function. Methods: Forty-five consecutive patients who had a reduced glomerular filtration rate and had at least two consecutive data regarding renal function prior to administration of levosimendan were enrolled in the study. Patients were classified into two groups as those with and without worsening renal function based on an increase in serum creatinine >0.3 mg/dL. Results: A significant improvement was noted in renal function in patients with worsening renal function (serum creatinine from 1.4 +/- 0.16 to 1.21 +/- 0.23 mg/dL, p=0.001 and glomerular filtration rate level from 48.9 +/- 15 to 59.3 +/- 21.8 mL/min/m(2), p=0.011), while there was no significant improvement in those without worsening renal function (serum creatinine from 1.29 +/- 0.33 to 1.37 +/- 0.66 mg/dL, p=0.240 and glomerular filtration rate level from 53.7 +/- 17.6 to 52.9 +/- 21.4 mL/min/m(2), p=0.850). Conclusion: Levosimendan appears to provide a renal-enhancing effect in patients with severe, acute decompensated systolic heart failure and worsening renal function. Consideration of this differential effect might help obtain beneficial renal outcomes. (Arq Bras Cardiol 2012;98(6):537-543)