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Cardiovascular Drugs and Therapy

, Volume 27, Issue 6, pp 581–590

First Online: 09 August 2013


Renal dysfunction is common in clinical settings in which cardiac function is compromised such as heart failure, cardiac surgery or sepsis, and is associated with high morbidity and mortality. Levosimendan is a calcium sensitizer and potassium channel opener used in the treatment of acute heart failure. This review describes the effects of the inodilator levosimendan on renal function. A panel of 25 scientists and clinicians from 15 European countries Austria, Finland, France, Hungary, Germany, Greece, Italy, Portugal, the Netherlands, Slovenia, Spain, Sweden, Turkey, the United Kingdom, and Ukraine convened and reached a consensus on the current interpretation of the renal effects of levosimendan described both in non-clinical research and in clinical study reports. Most reports on the effect of levosimendan indicate an improvement of renal function in heart failure, sepsis and cardiac surgery settings. However, caution should be applied as study designs differed from randomized, controlled studies to uncontrolled ones. Importantly, in the largest HF study REVIVE I and II no significant changes in the renal function were detected. As it regards the mechanism of action, the opening of mitochondrial KATP channels by levosimendan is involved through a preconditioning effect. There is a strong rationale for randomized controlled trials seeking beneficial renal effects of levosimendan. As an example, a study is shortly to commence to assess the role of levosimendan for the prevention of acute organ dysfunction in sepsis LeoPARDS.

KeywordsLevosimendan Renal dysfunction AbbreviationsHFHeart failure

AHFAcute heart failure

GFRGlomerular filtration rate

eGFREstimated glomerular filtration rate

NYHANew York Heart Association class

KATP channelAdenosine triphosphate-dependent potassium channel



L-NAMENω-nitro-L-arginine methyl ester


RBFRenal blood flow

CABGCoronary artery bypass grafting

MAPMean arterial pressure

RPVRenal parenchymal volume

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Author: Mehmet B. Yilmaz - Elena Grossini - José C. Silva Cardoso - István Édes - Francesco Fedele - Piero Pollesello - Matti 


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