Background Several animal studies suggest beneficial effects on kidney
function upon administration of levosimendan. As recent data from clinical
studies are heterogeneous, we sought to investigate whether levosimendan is
associated with improved postoperative kidney function in cardiac surgery
patients with respect to timing of its administration. Methods Retrospective,
single centre, observational analysis at a university hospital in Berlin,
Germany. All adult patients without preoperative renal dysfunction that
underwent coronary artery bypass grafting and/or valve
reconstruction/replacement between 01/01/2007 and 31/12/2011 were considered
for analyses. Results Out of 1.095 included patients, 46 patients were treated
with levosimendan due to a severely reduced left ventricular systolic function
preoperatively (LVEF < 35%) and/or clinical signs of a low cardiac output
syndrome. Sixty-one percent received the drug whilst in the OR, 39% after
postoperative intensive care unit admission. When levosimendan was given
immediately after anaesthesia induction, creatinine plasma levels (p = 0.009
for nonparametric analysis of longitudinal data in a two-factorial design) and
incidence of postoperative renal dysfunction (67.9% vs. 94.4%; p = 0.033) were
significantly reduced in contrast to a later start of treatment. In addition,
duration of renal replacement therapy was significantly shorter (79 [35;332]
vs. 272 [132;703] minutes; p = 0.046) in that group. Conclusions Postoperative
kidney dysfunction is a common condition in patients under going cardiac
surgery. Patients with severely reduced left ventricular function and/or
clinical signs of a low cardiac output syndrome who preoperatively presented
with a normal kidney function may benefit from an early start of levosimendan
administration, i.e. immediately after anaesthesia