Intravenous Amino Acids for Kidney Protection in Patients Undergoing Cardiac Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Overview

Journal J Int Med Res

Publisher Sage Publications

Date 2025 Feb 4

PMID 39901806

Authors

Malik Waleed Zeb Khan

Aizaz Ali

Amna Hussain

Aban Masaud Mian

Abdul Moeez

Waqas Inayat

Bushra Noor

Izhar Ali Shah

Muhammad Osama

Bushra Khan

Muhammad Sajid

Touba Azeem

Mohammad Ebad Ur Rehman

Ashraf Ali

Ubaid Khan Afridi

Affiliations

Soon will be listed here.

Abstract

Objective: To evaluate the efficacy of intravenous (IV) amino acids in preventing acute kidney injury (AKI) in patients undergoing cardiac surgery.

Methods: PubMed, EMBASE, and Cochrane Library databases were systematically searched for all relevant randomised controlled trials (RCTs) published from inception to July 25, 2024. A random effects model was used to pool the risk ratios (RR) for dichotomous outcomes, and the combined data was visually represented using forest plots.

Results: 3 studies involving 3646 patients were included in the meta-analysis. IV amino acids did not significantly lower the overall AKI incidence compared with control measures. However, they significantly reduced the risk of Stage 1 AKI and Stage 3 AKI. No differences were observed between intervention and control for Stage 2 AKI or need for kidney replacement therapy.

Conclusion: IV amino acids may offer protective benefits against severe AKI stages in cardiac surgery patients. Further studies are warranted to validate our findings.

References

Jufar A, Lankadeva Y, May C, Cochrane A, Bellomo R, Evans R . Renal functional reserve: from physiological phenomenon to clinical biomarker and beyond. Am J Physiol Regul Integr Comp Physiol. 2020; 319(6):R690-R702. DOI: 10.1152/ajpregu.00237.2020. View

Reents W, Hilker M, Borgermann J, Albert M, Plotze K, Zacher M . Acute kidney injury after on-pump or off-pump coronary artery bypass grafting in elderly patients. Ann Thorac Surg. 2014; 98(1):9-14. DOI: 10.1016/j.athoracsur.2014.01.088. View

Tolins J, Shultz P, Westberg G, Raij L . Renal hemodynamic effects of dietary protein in the rat: role of nitric oxide. J Lab Clin Med. 1995; 125(2):228-36. View

Page M, McKenzie J, Bossuyt P, Boutron I, Hoffmann T, Mulrow C . The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021; 372:n71. PMC: 8005924. DOI: 10.1136/bmj.n71. View

Goldet G, Howick J . Understanding GRADE: an introduction. J Evid Based Med. 2013; 6(1):50-54. DOI: 10.1111/jebm.12018. View

Landoni G, Monaco F, Ti L, Baiardo Redaelli M, Bradic N, Comis M . A Randomized Trial of Intravenous Amino Acids for Kidney Protection. N Engl J Med. 2024; 391(8):687-698. DOI: 10.1056/NEJMoa2403769. View

Landoni G, Szekely A, Comis M, Rodseth R, Pasero D, Ponschab M . Reducing mortality in acute kidney injury patients: systematic review and international web-based survey. J Cardiothorac Vasc Anesth. 2013; 27(6):1384-98. DOI: 10.1053/j.jvca.2013.06.028. View

Peng K, McIlroy D, Bollen B, Billings 4th F, Zarbock A, Popescu W . Society of Cardiovascular Anesthesiologists Clinical Practice Update for Management of Acute Kidney Injury Associated With Cardiac Surgery. Anesth Analg. 2022; 135(4):744-756. DOI: 10.1213/ANE.0000000000006068. View

E Hobson C, Yavas S, Segal M, Schold J, Tribble C, Layon A . Acute kidney injury is associated with increased long-term mortality after cardiothoracic surgery. Circulation. 2009; 119(18):2444-53. DOI: 10.1161/CIRCULATIONAHA.108.800011. View

10.

Sterne J, Savovic J, Page M, Elbers R, Blencowe N, Boutron I . RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019; 366:l4898. DOI: 10.1136/bmj.l4898. View

11.

Hsu R, Hsu C . The Role of Acute Kidney Injury in Chronic Kidney Disease. Semin Nephrol. 2016; 36(4):283-92. PMC: 4979984. DOI: 10.1016/j.semnephrol.2016.05.005. View

12.

Kazawa M, Kabata D, Yoshida H, Minami K, Maeda T, Yoshitani K . Amino acids to prevent cardiac surgery-associated acute kidney injury: a randomized controlled trial. JA Clin Rep. 2024; 10(1):19. PMC: 10963352. DOI: 10.1186/s40981-024-00703-6. View

13.

James M, Samuel S, Manning M, Tonelli M, Ghali W, Faris P . Contrast-induced acute kidney injury and risk of adverse clinical outcomes after coronary angiography: a systematic review and meta-analysis. Circ Cardiovasc Interv. 2013; 6(1):37-43. DOI: 10.1161/CIRCINTERVENTIONS.112.974493. View

14.

Kellum J, Bellomo R, Ronco C . Kidney attack. JAMA. 2012; 307(21):2265-6. DOI: 10.1001/jama.2012.4315. View

15.

Ostermann M, Kunst G, Baker E, Weerapolchai K, Lumlertgul N . Cardiac Surgery Associated AKI Prevention Strategies and Medical Treatment for CSA-AKI. J Clin Med. 2021; 10(22). PMC: 8618011. DOI: 10.3390/jcm10225285. View

16.

Karkouti K, Wijeysundera D, Yau T, Callum J, Cheng D, Crowther M . Acute kidney injury after cardiac surgery: focus on modifiable risk factors. Circulation. 2009; 119(4):495-502. DOI: 10.1161/CIRCULATIONAHA.108.786913. View

17.

Landoni G, Pasin L, Monti G, Cabrini L, Beretta L, Zangrillo A . Towards zero perioperative mortality. Heart Lung Vessel. 2013; 5(3):133-6. PMC: 3848670. View

18.

Zhu R, Allingstrup M, Perner A, Doig G . The Effect of IV Amino Acid Supplementation on Mortality in ICU Patients May Be Dependent on Kidney Function: Post Hoc Subgroup Analyses of a Multicenter Randomized Trial. Crit Care Med. 2018; 46(8):1293-1301. DOI: 10.1097/CCM.0000000000003221. View

19.

Zarbock A, Kullmar M, Ostermann M, Lucchese G, Baig K, Cennamo A . Prevention of Cardiac Surgery-Associated Acute Kidney Injury by Implementing the KDIGO Guidelines in High-Risk Patients Identified by Biomarkers: The PrevAKI-Multicenter Randomized Controlled Trial. Anesth Analg. 2021; 133(2):292-302. DOI: 10.1213/ANE.0000000000005458. View

20.

Bove T, Monaco F, Covello R, Zangrillo A . Acute renal failure and cardiac surgery. HSR Proc Intensive Care Cardiovasc Anesth. 2013; 1(3):13-21. PMC: 3484552. View