• RedaelliMartina BaiardoMB0000-0002-4232-1713Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy., Fabrizio Monaco, Nikola Bradic, Anna Mara Scandroglio, TiLian KahLKDepartment of Anaesthesia, National University Hospital, Singapore., Alessandro Belletti, Cristina Viscido, Margherita Licheri, Fabio Guarracino, Alessandro Pruna, Antonio Pisano, Domenico Pontillo, Francesco Federici, Rosario Losiggio, Giovanni Serena, Enrico Tomasi, Simona Silvetti, Marco Ranucci, Luca Brazzi, Andrea Cortegiani, Giovanni Landoni, Pasquale Mastroroberto, Gianluca Paternoster, Mario F L Gaudino, Alberto Zangrillo, Rinaldo Bellomo, and PROTECTION Study Group Collaborators.
• Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
• Anesthesiology. 2024 Dec 19.

BackgroundIn the PROTECTION trial, intravenous amino acids (AA) decreased the occurrence of acute kidney injury (AKI) in cardiac surgery patients with cardiopulmonary bypass (CPB). Recruitment of renal functional reserve may be responsible for such protection. However, patients with chronic kidney disease (CKD) have diminished renal functional reserve, and AA may be less protective in such patients. Thus, a separate investigation of such patients is warranted.MethodsWe defined CKD as an estimated glomerular filtration rate (eGFR)<60 mL·min-1·1.73 m-2 and patients with eGFR≥60 mL·min-1·1.73 m-2 served as controls. The primary outcome was the occurrence of AKI. Secondary outcomes included severity of AKI, need for and duration of renal replacement therapy, and all-cause mortality.ResultsAmong CKD patients (n=812), compared with placebo, AA significantly decreased the rate of AKI (43.1% vs 50.3%; RR, 0.86; 95%CI, 0.74 to 0.99; p=0.041; number needed to treat [NNT]=14) with a median percentage increase in eGFR from baseline to postoperative day three of 12.7% vs. 6.5% (p=0.002). In eGFR-based CKD subgroups (30 to 39, 40 to 49, and 50 to 59 mL·min-1·1.73 m-2) the AA effect was similar (interaction p=0.50). Finally, AA infusion decreased the occurrence of severe (stage 3) AKI (2.7% vs. 5.6%; RR 0.48; 95%CI, 0.24 to 0.98; p=0.038).ConclusionsAA infusion protected CKD patients undergoing CPB from developing AKI, with an absolute risk reduction of 7% and a NNT of 14 in a cohort with a >45% rate of AKI. Moreover, it delivered a >50% relative risk reduction in severe AKI.Copyright © 2024 American Society of Anesthesiologists. All Rights Reserved.

13 keywords...

hide…