The Role of Levosimendan Infusion in Improving Renal Function in Worsening Type II Cardio-Renal Syndrome

The cardio-renal syndrome (CRS) includes a variety of pathologic conditions (acute or chronic) where the primary failing organ can be either the heart or the kidney. We present three cases of heart failure (HF) patients hospitalized for acute decompensation, who presented a CRS type II rapidly worsening after high doses of furosemide infusion. METHODS: From June 2015 to March 2016 all patients admitted to our Department for chronic refractory heart failure (NYHA class IV), underwent a determination of BNP and other laboratory tests (creatinine, GFR, haemoglobin), echocardiogram, non-invasive cardiac output measurement and 6 min walking test. Patients underwent a single infusion of levosimendan in case of CRS type II, at 0.1 µg/kg/min for 24-36 hours. Clinical / laboratory evaluation was repeated 24 hours and 1 week after infusion of the drug. RESULTS: Patients treated with levosimendan allowed the reduction of loop diuretics dose, because of the restoration of renal function. Body weight and peripheral edema were progressively reduced, and cardiac output improved. At discharge, exercise capacity significantly improved, functional class proved to be in NYHA class II-III, renal function and neurohormonal assessment (BNP) ameliorated. At one-month follow-up the clinical conditions remained stable as well as the parameters of renal function and plasma BNP. CONCLUSION: This clinical experience demonstrated that one of most frequent and dangerous evolution of renal impairment (development of Acute Kidney Injury) might be improved by using a single dose of levosimendan, which has a proved effect in improving cardiac function and urine output.