Acute kidney injury (AKI) is a frequent and severe complication following cardiac surgery, often due to reduced kidney perfusion. This study evaluates whether the intravenous infusion of amino acids can reduce the occurrence of AKI in patients undergoing cardiac surgery with cardiopulmonary bypass. The trial aimed to provide evidence on the efficacy of amino acids in improving kidney outcomes post-surgery.
The study was a multinational, double-blind, randomized trial involving 3511 adult patients across 22 centers in three countries. Patients scheduled for cardiac surgery with cardiopulmonary bypass were randomly assigned to receive either an intravenous infusion of a balanced mixture of amino acids (2 g per kilogram of ideal body weight per day) or a placebo (Ringer’s solution) for up to three days. The primary outcome was the occurrence of AKI, defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) creatinine criteria. Secondary outcomes included the severity of AKI, the use and duration of kidney-replacement therapy, and 30-day all-cause mortality.
The study found that AKI occurred in 26.9% of patients in the amino acid group compared to 31.7% in the placebo group (relative risk, 0.85; 95% CI, 0.77 to 0.94; P=0.002), indicating a significant reduction in the occurrence of AKI among those receiving amino acids. Additionally, Stage 3 AKI occurred in 1.6% of the amino acid group versus 3.0% in the placebo group (relative risk, 0.56; 95% CI, 0.35 to 0.87). The use of kidney-replacement therapy was lower in the amino acid group (1.4%) compared to the placebo group (1.9%). There were no substantial differences in other secondary outcomes or adverse events between the two groups.
The infusion of amino acids significantly reduced the occurrence of AKI in adult patients undergoing cardiac surgery. This finding suggests that amino acid infusion could be an effective intervention to mitigate the risk of AKI in this high-risk population. Further research is warranted to explore the broader implications of these findings on patient outcomes and healthcare practices.
Landoni, G. et al. (2024) “A randomized trial of intravenous amino acids for kidney protection,” The New England journal of medicine, 391(8), pp. 687–698. doi: 10.1056/nejmoa2403769.
