Alessandro Pruna, Rosario Losiggio, Giovanni Landoni, Yuki Kotani, Martina Baiardo Redaelli, Marta Veneziano, Todd C Lee, Alberto Zangrillo, Mario F L Gaudino, Rinaldo Bellomo
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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":"{\"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. 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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. 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引用次数: 0
摘要
目的:急性肾损伤(AKI)是一种常见的围手术期并发症。迄今为止,还没有任何一种干预措施能有效预防这种情况下的急性肾损伤。然而,静脉注射氨基酸(AA)可恢复肾功能储备,从而减轻围手术期肾小球滤过率的下降:我们进行了一项荟萃分析,以评估输注 AA 对围手术期肾功能保护的功效:我们对围术期患者的对照研究进行了荟萃分析,评估了静脉输注AA与任何对比研究的效果:主要结果是随访时间最长的AKI。我们根据相对风险(RR)表进行了随机效应荟萃分析,以评估AA输注的效果。我们采用贝叶斯方法来估计主要结果的获益概率(RR < 1)。次要结果包括肾脏替代治疗、血清肌酐和估计肾小球滤过率。三级结果包括机械通气持续时间、重症监护室和住院时间以及死亡率(PROSPERO:CRD42024547225):我们确定了 15 项研究(14 项随机对照试验和 1 项前瞻性前后研究)至少报告了一项相关结果(4544 名患者),其中 6 项研究(4084 名患者)报告了主要结果。在 2,041 例 AA 患者中,504 例(24.7%)发生了 AKI,而在 2,041 例对照患者中,614 例(30.1%)发生了 AKI(RR,0.66;95% 置信区间,0.47-0.94;I2 = 50%;P = 0.02),AA 减少 AKI 的概率为 99.1%。此外,与这些研究结果一致的是,AA可减少血清肌酐和住院时间,增加肾小球滤过率:这项荟萃分析表明,使用 AA 有可能降低围手术期 AKI 的发生率。
Amino Acid Infusion for Perioperative Functional Renal Protection: A Meta-analysis.
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.