• Alessandro Pruna, Rosario Losiggio, Giovanni Landoni, Yuki Kotani, RedaelliMartina BaiardoMBDepartment of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy., Marta Veneziano, Todd C Lee, Alberto Zangrillo, Mario F L Gaudino, Rinaldo Bellomo, and for Protection Study group.
• Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
• J. Cardiothorac. Vasc. Anesth. 2024 Dec 1; 38 (12): 307630853076-3085.

ObjectivesAcute kidney injury (AKI) is a common perioperative complication. To date, no single intervention has been proven effective for AKI prevention in this setting. However, intravenous amino acids (AA) administration may recruit renal functional reserve and, thereby, attenuate the perioperative loss of the glomerular filtration rate.DesignWe performed a meta-analysis to assess the efficacy of AA infusion for perioperative renal functional protection.Setting And ParticipantsWe performed a meta-analysis of controlled studies in perioperative patients evaluating intravenous AA infusion versus any comparator.MeasurementsThe primary outcome was AKI at longest follow-up. We performed a random effects meta-analysis on the relative risk (RR) scale to assess the effect of AA infusion. We used a Bayesian approach to estimate the probability of benefit (RR < 1) for the primary outcome. Secondary outcomes included renal replacement therapy, serum creatinine, and estimated glomerular filtration rate. Tertiary outcomes included mechanical ventilation duration, intensive care unit and hospital length of stay and mortality (PROSPERO: CRD42024547225).ResultsWe identified 15 studies (14 randomized controlled trials and 1 prospective before-after study) reporting at least one outcome of interest (4,544 patients), with 6 studies (4,084 patients) reporting the primary outcome. AKI occurred 504 of 2,041 (24.7%) in AA patients versus 614 of 2,041 (30.1%) in controls (RR, 0.66; 95% confidence interval, 0.47-0.94; I2 = 50%; p = 0.02), which corresponded with a 99.1% probability of AKI reduction with AA. Moreover, consistent with these findings, AA decreased serum creatinine and hospital length of stay and increased the estimated glomerular filtration rate.ConclusionsThis meta-analysis suggests that AA administration likely decreased the perioperative incidence of AKI.Copyright © 2024 Elsevier Inc. All rights reserved.

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