Effect of levosimendan on renal function in background of left ventricular dysfunction: a meta-analysis of randomized trials

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, I² = 52.5%, high quality) and the risk of ARF (relative risk 0.75, 95%CI (0.60, 0.95), P = 0.017, I² = 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, I² = 55.1%, low-quality) and urine output (SMD 0.42, 95%CI (0.06, 0.79), P = 0.024, I² = 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, I² = 77.9%, very low-quality). Levosimendan might improve renal function of patients with LVD.