The New England Journal of MedicineA Randomized Trial of Intravenous Amino Acids for Kidney Protection

Potential Role of Amino Acids in Reducing Cardiac Surgery-Associated Kidney Injury

Intravenous amino acids have been investigated for their potential to mitigate acute kidney injury (AKI) in patients undergoing cardiac surgery, a common and serious complication associated with reduced kidney perfusion. This randomized, double-blind trial assessed the efficacy of amino acid infusions in reducing the incidence and severity of AKI in a large, multinational cohort of patients.

Study Design:

• Multinational, double-blind trial with 3511 adult patients scheduled for cardiac surgery with cardiopulmonary bypass.
• Participants were randomly assigned to receive either a balanced mixture of amino acids (2 g/kg of ideal body weight per day) or placebo (Ringer’s solution) for up to 3 days.
• 1759 patients received amino acids; 1752 patients received placebo.
• Primary outcome: occurrence of AKI according to the Kidney Disease: Improving Global Outcomes creatinine criteria.
• Secondary outcomes: severity of AKI, use and duration of kidney-replacement therapy, all-cause 30-day mortality.

Key Findings:

• AKI occurred in 26.9% of the amino acid group vs. 31.7% in the placebo group (relative risk, 0.85; 95% CI, 0.77 to 0.94; P=0.002).
• Stage 3 AKI occurred in 1.6% of the amino acid group vs. 3.0% in the placebo group (relative risk, 0.56; 95% CI, 0.35 to 0.87).
• Kidney-replacement therapy was used in 1.4% of the amino acid group vs. 1.9% in the placebo group.
• No substantial differences in other secondary outcomes or adverse events between the groups.

HCN Medical Memo
Intravenous amino acids may offer a protective benefit against acute kidney injury in patients undergoing cardiac surgery. This finding supports the consideration of amino acid infusions as a potential strategy for reducing AKI incidence in this high-risk population.

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