Effects of levosimendan on renal function in septic shock: a case–control study

Introduction

Nonhemodynamic mechanisms of cell injury might play a role in the loss of glomerular filtration rate during sepsis [1]. We hypothesized that levosimendan may positively affect renal function by a combination of systemic and regional hemodynamic, anti-inflammatory and anti-apoptotic effects. We therefore performed a case–control study to investigate the effects of levosimendan on creatinine clearance in patients with septic shock.

Methods

Ninety-nine septic shock patients received levosimendan (0.2 μg/kg/min for 24 hours) within the first 36 hours following onset of septic shock. For each study patient, a control subject from a group of patients with septic shock of an institutional database was matched for Simplified Acute Physiology Score II, baseline creatinine concentration, delay from shock onset, age, and gender. Serum creatinine concentrations were analyzed just before the start of the 24-hour period of levosimendan infusion (baseline) and 96 hours after levosimendan had been initiated. The glomerular filtration rate was estimated by applying the Cockcroft–Gault formula.

Results

Compared with the control cohort, levosimendan significantly increased the glomerular filtration rate after 96 hours (62 ± 46 vs. 50 ± 33 ml/min, P < 0.05). In addition, the maximum serum creatinine concentration was lower in the levosimendan group (2.2 ± 1.3 vs. 2.6 ± 2 mg/dl, P < 0.05 vs. control) during the 96-hour study period.

Conclusion

The present data suggest that levosimendan may improve renal function in patients with septic shock.