- Acute kidney injury (AKI) is a common and serious complication of cardiac surgery, particularly among patients with preexisting chronic kidney disease (CKD).
- Intravenous amino acid (AA) infusions have been hypothesized to reduce the risk of AKI in the perioperative setting, primarily by recruiting renal functional reserve and thereby increasing glomerular infiltration rate (GFR).
- A large, multicenter, double-blind randomized trial (the PROTECTION trial) previously demonstrated a benefit of AA infusions in reducing postoperative AKI following cardiac surgery utilizing cardiopulmonary bypass.
- To address whether this renal protection extended to patients with impaired baseline renal function, the investigators for this article performed a prespecified subgroup analysis within the PROTECTION trial.
- Adult patients undergoing elective on-pump cardiac procedures were randomized to receive either AA infusion (2 g/kg/day) or placebo starting in the operating room and continuing up to 72 hours postoperatively.
- Among 812 patients with CKD (defined by a preoperative eGFR <60 mL/min/1.73 m²), those treated with AA infusion experienced significantly fewer episodes of postoperative AKI compared to those treated with placebo (43.1% vs. 50.3%, RR 0.86, P = 0.041).
- Moreover, treatment with AA infusion more than halved the incidence of severe (stage 3) AKI when compared with treatment with placebo (2.7% vs. 5.6%, RR 0.48, P = 0.038).
- The authors concluded that amino acid infusion is a low-risk, cost-effective intervention that reduces AKI incidence and severity in cardiac surgery patients with preexisting CKD.
Summary of "Amino Acid Infusion for Kidney Protection in Cardiac Surgery Patients with Chronic Kidney Disease: A Secondary Analysis of the PROTECTION Trial"
Summary published June 23, 2025
