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A Randomized Trial of Intravenous Amino Acids for Kidney Protection
Giovanni Landoni1, Fabrizio Monaco1, Lian Kah Ti1
1From the Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute (G.L., F.M., M.B.R., A.M.S., A.F., M.G.C., G.B., A. Belletti, C.G., G.G., C.N., M.L., A.L.D.P., S.F., R. Labanca, M.M., R. Lembo, R. Losiggio, E.F., A.Z.), Vita-Salute San Raffaele University (G.L., A.Z.), and Dipartimento di Chirurgia Cardiovascolare, Unità Operativa di Anestesia e Terapia Intensiva, IRCCS Centro Cadiologico Monzino (C.B.), Milan, S.C. Anestesia e Rianimazione Cardiovascolare, A.O. Ordine Mauriziano Umberto I di Torino, Turin (M.C., C.V., S.P., F. Ferrod), the Department of Medical and Surgical Sciences, University Hospital "R. Dulbecco," Magna Graecia University, Catanzaro (E.G., A. Bruni, F.L.), Cardiovascular Anesthesia and ICU San Carlo Hospital, Potenza (G.P., A. Covino), Cardiac Anesthesia and ICU, AORN "Dei Colli," Monaldi Hospital, Naples (A.P., M.V.), the Department of Medicine, University of Udine (I.V., T.B.), the Division of Cardiac Surgery, Azienda Sanitaria Universitaria Friuli Centrale (I.V.), and the Department of Anesthesia and Intensive Care Medicine, ASUFC University-Hospital of Central Friuli (T.B.), Udine, UOC Anestesia e Rianimazione, Azienda Ospedaliero Universitaria Sant'Andrea (F. Federici), and UO Complessa Anestesia e Rianimazione, Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera San Camillo Forlanini (L.S.), Rome, the Department of Precision Medicine in Medical, Surgical and Critical Care, University of Palermo, and the Department of Anesthesia Analgesia Intensive Care and Emergency, University Hospital Policlinico Paolo Giaccone, Palermo (A. Cortegiani), the Department of Cardiovascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese (E.B., M.R.), IRCCS Humanitas Research Hospital, Anestesia e Terapia Intensiva Cardiochirurgica, Rozzano (D.K.), the Department of Anesthesia and ICU Maria Cecilia Hospital GVM Care and Research, Cotignola (L.M.), the Department of Cardiac Anesthesia and Intensive Care, Ospedale Policlinico San Martino IRCCS-IRCCS Cardiovascular Network, Genoa (S.S.), the Department of Cardiothoracic and Vascular Anaesthesia and Intensive Care, Azienda Ospedaliero Universitaria Pisana, Pisa (F.G.), and the Department of Anesthesia, Intensive Care and Emergency, 'Citta della Salute e della Scienza' University Hospital, Turin (R. Lobreglio) - all in Italy; the Department of Anaesthesia, National University Hospital, Singapore (L.K.T.); the Clinic of Anesthesiology, Resuscitation, and Intensive Medicine, University Hospital Dubrava, Zagreb, and University North, Department of Nursing, Varazdin - both in Croatia (N.B.); the Department of Intensive Care Medicine, Kameda Medical Center, Kamogawa, Japan (Y.K.); and the Department of Critical Care, University of Melbourne, the Australian and New Zealand Intensive Care Research Centre, Monash University, and the Department of Intensive Care, Austin Hospital - all in Melbourne, VIC, Australia (R.B.).
Intravenous amino acids significantly reduced acute kidney injury (AKI) after cardiac surgery. This intervention improved kidney perfusion and renal reserve, offering a potential new strategy for preventing AKI in high-risk patients.
Area of Science:
- Nephrology
- Cardiology
- Critical Care Medicine
Background:
- Acute kidney injury (AKI) is a frequent and severe complication following cardiac surgery.
- Reduced kidney perfusion is a primary factor contributing to AKI in this patient population.
- The potential benefit of intravenous amino acids in mitigating cardiac surgery-associated AKI remains uncertain.
Purpose of the Study:
- To evaluate the efficacy of intravenous amino acid infusion in reducing the incidence of AKI in adult patients undergoing cardiac surgery.
- To assess secondary outcomes including AKI severity, need for kidney-replacement therapy, and 30-day mortality.
Main Methods:
- A multinational, double-blind, randomized trial involving 3511 adult patients scheduled for cardiac surgery with cardiopulmonary bypass.
- Patients received either a balanced amino acid mixture (2 g/kg/day) or placebo (Ringer's solution) intravenously for up to 3 days.
- AKI was defined by Kidney Disease: Improving Global Outcomes (KDIGO) creatinine criteria; secondary outcomes were also monitored.
Main Results:
- The incidence of AKI was lower in the amino acid group (26.9%) compared to the placebo group (31.7%), with a relative risk of 0.85 (95% CI, 0.77 to 0.94; P=0.002).
- Stage 3 AKI occurred less frequently in the amino acid group (1.6% vs. 3.0%).
- Rates of kidney-replacement therapy and 30-day mortality showed no substantial differences between groups.
Conclusions:
- Intravenous amino acid infusion effectively reduced the occurrence of AKI in adult patients undergoing cardiac surgery.
- Amino acid administration may represent a protective strategy against AKI in the context of cardiac surgery.
- Further research may explore optimal dosing and specific patient subgroups who benefit most.
Related Concept Videos
Acute Kidney Injury I: Introduction
Acute Kidney Injury II: Pathophysiology
Acute Kidney Injury III: Clinical Manifestations
Acute Kidney Injury IV: Diagnostic Studies and Prevention
Acute Kidney Injury V: Interprofessional Care
Acute Kidney Injury VI: Nursing Management

