Key result
Levosimendan and tolvaptan may improve renal function in type 1 cardiorenal syndrome, unlike ultrafiltration or dopamine.
Why the study?
There is limited evidence or guidelines for managing cardiorenal syndrome type 1, and established strategies mainly target symptomatic relief of heart failure.
Do various pharmacological and mechanical treatment strategies improve renal function and clinical parameters in patients with cardiorenal syndrome type 1?
Systematic Review (n=754)
Do various pharmacological and mechanical treatment strategies improve renal function and clinical parameters in patients with cardiorenal syndrome type 1?
In cardiorenal syndrome type 1, levosimendan and tolvaptan may offer renal benefits and improve diuresis, while routine use of low-dose dopamine or nesiritide is not supported for preserving renal function.
Levosimendan or tolvaptan may merit consideration in CRS-1 while avoiding dopamine/nesiritide; extends evidence synthesis but leaves open need for definitive RCTs.
Cardiorenal syndrome (CRS) type 1 is the development of acute kidney injury in patients with acute decompensated heart failure. CRS often results in prolonged hospitalization, a higher rate of rehospitalization, high morbidity, and high mortality. The pathophysiology of CRS is complex and involves hemodynamic changes, neurohormonal activation, hypothalamic-pituitary stress reaction, inflammation, and infection. However, there is limited evidence or guideline in managing CRS type 1, and the established therapeutic strategies mainly target the symptomatic relief of heart failure. This review will discuss the strategies in the management of CRS type 1. Six clinical studies have been included in this review that include different treatment strategies such as nesiritide, dopamine, levosimendan, tolvaptan, dobutamine, and ultrafiltration. Treatment strategies for CRS type 1 are derived based on the current literature. Early recognition and treatment of CRS can improve the outcomes of the patients significantly.
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Leong Tung Ong (2021) conducted a systematic review in Cardiorenal syndrome type 1 (acute decompensated heart failure with renal dysfunction) (n=754). Various pharmacological and mechanical therapies (nesiritide, dopamine, levosimendan, tolvaptan, dobutamine, ultrafiltration) vs. Standard therapy, placebo, or active comparators was evaluated on Changes in renal function tests (creatinine, GFR, BUN, cystatin C, urine output, weight). Current evidence for managing cardiorenal syndrome type 1 indicates that levosimendan and tolvaptan may improve renal parameters, whereas ultrafiltration and low-dose dopamine or nesiritide do not provide significant renal benefits.
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