Alessandro Pruna, Rosario Losiggio, Giovanni Landoni, Yuki Kotani, Martina Baiardo Redaelli, Marta Veneziano, Todd C Lee, Alberto Zangrillo, Mario F L Gaudino, Rinaldo Bellomo
{"title":"Amino Acid Infusion for Perioperative Functional Renal Protection: A Meta-analysis.","authors":"Alessandro Pruna, Rosario Losiggio, Giovanni Landoni, Yuki Kotani, Martina Baiardo Redaelli, Marta Veneziano, Todd C Lee, Alberto Zangrillo, Mario F L Gaudino, Rinaldo Bellomo","doi":"10.1053/j.jvca.2024.08.033","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>Acute 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.</p><p><strong>Design: </strong>We performed a meta-analysis to assess the efficacy of AA infusion for perioperative renal functional protection.</p><p><strong>Setting and participants: </strong>We performed a meta-analysis of controlled studies in perioperative patients evaluating intravenous AA infusion versus any comparator.</p><p><strong>Measurements: </strong>The 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).</p><p><strong>Results: </strong>We 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; I<sup>2</sup> = 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.</p><p><strong>Conclusions: </strong>This meta-analysis suggests that AA administration likely decreased the perioperative incidence of AKI.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":null,"pages":null},"PeriodicalIF":2.3000,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of cardiothoracic and vascular anesthesia","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1053/j.jvca.2024.08.033","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Objectives: Acute 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.
Design: We performed a meta-analysis to assess the efficacy of AA infusion for perioperative renal functional protection.
Setting and participants: We performed a meta-analysis of controlled studies in perioperative patients evaluating intravenous AA infusion versus any comparator.
Measurements: The 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).
Results: We 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.
Conclusions: This meta-analysis suggests that AA administration likely decreased the perioperative incidence of AKI.
期刊介绍:
The Journal of Cardiothoracic and Vascular Anesthesia is primarily aimed at anesthesiologists who deal with patients undergoing cardiac, thoracic or vascular surgical procedures. JCVA features a multidisciplinary approach, with contributions from cardiac, vascular and thoracic surgeons, cardiologists, and other related specialists. Emphasis is placed on rapid publication of clinically relevant material.