The following is a summary of “A randomized trial of Intravenous amino acids for kidney protection,” published in the June 2024 issue of Nephrology by Landoni et al.
Acute kidney injury (AKI) is a severe and common complication that follows heart surgery due to reduced kidney perfusion. Amino acids have been suggested to increase kidney perfusion. However, extensive studies are required.
Researchers conducted a prospective study analyzing the efficacy of intravenous amino acids in helping kidney function better and lowering AKI risk after cardiac surgery.
They reviewed adult patients undergoing cardiac surgery with cardiopulmonary bypass and assigned them to receive either intravenous amino acids (2g per kg of ideal body weight per day) or a placebo (Ringer’s solution) for up to 3 days. The primary outcome was AKI occurrence based on Kidney Disease, Improving Global Outcomes criteria, with secondary outcomes including AKI severity, kidney-replacement therapy use, and 30-day mortality.
The results showed 3,511 patients across 22 centers, with 1,759 in the amino acid group and 1,752 in the placebo group. The AKI rates were 26.9% with amino acid (n=474) vs. 31.7% with placebo (n=555) (RR 0.85, 95% CI 0.77-0.94, P=0.002). Stage 3 AKI occurred in 1.6% and 3.0%, respectively (RR 0.56, 95% CI 0.35-0.87). Kidney-replacement therapy rates were 1.4% (24 patients) and 1.9% (33 patients) respectively. No significant differences in other outcomes or AEs.
Investigators concluded that giving amino acids during cardiac surgery to adult patients lowered the risk of AKI.
Source: nejm.org/doi/full/10.1056/NEJMoa2403769
