J BAI1,2, N YE1, M GALLAGHER1, A WANG1
1George Institute For Global Health, Sydney, Australia, 2Beijing Friendship Hospital Affiliated to Capital University of Medical Science, Beijing, China
Aim: Review the effect of inotropes in patients with cardio-renal syndrome.
Background: Cardio-renal syndrome (CRS) is associated with an increased risk of morbidity and mortality, however there is limited evidence to provide a specific treatment strategy and the role of inotropic drugs in this setting remains unclear.
Method: A systematic review with meta-analysis of randomized controlled trials was performed to assess the effect of inotropic in non-surgical patients with cardio-rena.l syndrome. Databases included MEDLINE, Cochrane Library, and EMBASE (OVID interface, 1946 to November 18, 2019). The primary outcome of this study was improvement in renal function. Secondary outcomes included all-cause mortality and cardiac function. Pooled analysis was performed using a random-effect model.
Results: The search yielded 15 trials, which included a total of 1061 patients. 7 trials compared levosimendan with either placebo or dobutamine, 5 trials compared the combination of dopamine and furosemide with furosemide only, 2 trials comapred dopamine with either placebo or furosemide, and 1 trial compared dobutamine with prostaglandin E1 (PGE1). Levosimendan was associated with improvement in renal function with a change of eGFR when compared with dobutamine (SMD 0.46, 95%CI 0.07-0.84), and placebo (SMD 1.57, 95%CI 0.42-2.73). Levosimendan also reduced serum BNP level compared to placebo. No survival differences seen when comparing levosimendan to placebo, or when comparing furosemide to combined low dose dopamine and furosemide.
Conclusion: Our review showed that the use of levosimendan was associated with an improvement in renal and cardiac function in patients with cardio-renal syndrome, but with no survival benefits. Further large randomized controlled trials are required to assess the effect of inotropic drugs in CRS.
Jing Bai is an Attending Physician at Department of Critical Care Medicine, Beijing Friendship Hospital Affiliated to Capital University of Medical Science.Visiting Follow of the Renal and Metabolic Division in the George Institute.Jing’s research interests include clinical trials to explore ways to improve the outcomes of patients with kidney disease (esp in the setting of acute kidney injury).