A Randomized Trial of Intravenous Amino Acids for Kidney Protection
In a large multinational trial of cardiac-surgery patients, a 3-day infusion of balanced amino acids lowered the rate of postoperative acute kidney injury compared with placebo, offering a simple, low-cost nephroprotective option.
Background
Acute kidney injury is a common and serious complication of cardiac surgery, with reduced kidney perfusion a key contributing factor. Intravenous amino acids increase kidney perfusion and recruit renal functional reserve, but whether this prevents AKI was uncertain.
Study design
In a multinational, double-blind trial at 22 centers in three countries, 3,511 adults scheduled for cardiac surgery with cardiopulmonary bypass were randomized to an intravenous infusion of balanced amino acids (2 g/kg ideal body weight per day) or placebo (Ringer's solution) for up to 3 days.
Key findings
AKI occurred in 26.9% of the amino acid group versus 31.7% of the placebo group (relative risk 0.85; 95% CI 0.77-0.94; P=0.002). Stage 3 AKI was also less frequent (1.6% vs 3.0%; relative risk 0.56).
Clinical implications
A short course of amino acid infusion offers a low-cost, broadly available strategy to reduce AKI after cardiac surgery, although there were no substantial differences in kidney-replacement therapy use or 30-day mortality between groups.
Safety
There were no substantial differences between the groups in adverse events.
Category
Research
Source
New England Journal of Medicine
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