IV Amino Acids Administration Reduces Perioperative Acute Kidney Injury Risk, States study

Acute kidney injury (AKI) is a frequent and serious complication during the perioperative period that affects multiple patients undergoing surgery. Despite the considerable impact of AKI on patient outcomes, no single intervention has been universally effective in preventing this condition. However, recent findings published in the Journal of Cardiothoracic and Vascular Anesthesia suggested that intravenous administration of amino acids (AA) may offer a promising approach to reduce the risk of AKI by recruiting renal functional reserve and preserving glomerular filtration rate during the perioperative period.

A comprehensive meta-analysis evaluated the efficacy of AA infusion in protecting renal function among perioperative patients. The analysis included 15 controlled studies, with a total of 4,544 patients, of which 4,084 patients were involved in studies specifically reporting on the primary outcome of interest (AKI) at the longest follow-up period.

The results of the meta-analysis revealed a significant reduction in the incidence of AKI among patients who received intravenous AA. Also, AKI was observed in 24.7% of patients who received AA when compared to 30.1% of the participants in the control group. This corresponded to a relative risk reduction (RR) of 0.66 (95% CI, 0.47 to 0.94; I2 = 50%; p = 0.02) which suggested a 34% decrease in the likelihood of developing AKI with AA administration. The probability of this reduction was calculated to be 99.1% by indicating a high likelihood that AA infusion offers a protective effect against AKI.

Beyond the primary outcome, the meta-analysis also examined secondary outcomes related to renal function and overall patient recovery. The findings were consistent with the primary outcome by showing that AA administration led to a reduction in serum creatinine level and an increase in estimated glomerular filtration rate (eGFR). This indicated a better overall kidney performance and the patients who received AA infusion experienced shorter hospital stays, reflecting a faster recovery process.

While the primary focus was on renal protection, the analysis also explored tertiary outcomes, including the duration of mechanical ventilation, length of stay in the intensive care unit (ICU), and overall mortality. Although these outcomes were not the primary focus, the results suggested a trend toward improved recovery and reduced mortality in patients receiving AA infusion. While these results are promising, further studies are imperative to validate the findings across a broader range of patient populations and surgical procedures.

Reference:

Pruna, A., Losiggio, R., Landoni, G., Kotani, Y., Redaelli, M. B., Veneziano, M., Lee, T. C., Zangrillo, A., Gaudino, M. F. L., & Bellomo, R. (2024). Amino Acid Infusion for Perioperative Functional Renal Protection: A Meta-analysis. In Journal of Cardiothoracic and Vascular Anesthesia. Elsevier BV. https://doi.org/10.1053/j.jvca.2024.08.033