Amino Acid Infusion for Kidney Protection in Cardiac Surgery Patients with Chronic Kidney Disease: A Secondary Analysis of the PROTECTION Trial.

IF 9.1 1区医学 Q1 ANESTHESIOLOGY

Anesthesiology Pub Date : 2025-03-07 DOI:10.1097/ALN.0000000000005336

Martina Baiardo Redaelli, Fabrizio Monaco, Nikola Bradic, Anna Mara Scandroglio, Lian Kah Ti, 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

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引用次数: 0

Abstract

Background: In the PROTECTION trial (Intravenous Amino Acid Therapy for Kidney Protection in Cardiac Surgery), intravenous amino acids decreased the occurrence of acute kidney injury in cardiac surgery patients with cardiopulmonary bypass. Recruitment of renal functional reserve may be responsible for such protection. However, patients with chronic kidney disease have diminished renal functional reserve, and amino acids may be less protective in such patients. Thus, a separate investigation of such patients is warranted.

Methods: For this study chronic kidney disease was defined as an estimated glomerular filtration rate of less than 60 ml · min -1 · 1.73 m -2 , and patients with estimated glomerular filtration rates greater than or equal to 60 ml · min -1 · 1.73 m -2 served as controls. The primary outcome was the occurrence of acute kidney injury. Secondary outcomes included severity of acute kidney injury, need for and duration of renal replacement therapy, and all-cause mortality.

Results: Among chronic kidney disease patients (n = 812), compared with placebo, amino acids significantly decreased the rate of acute kidney injury (43.1% vs 50.3%; relative risk, 0.86; 95% CI, 0.74 to 0.99; P = 0.041; number needed to treat = 14) with a median percentage increase in estimated glomerular filtration rate from baseline to postoperative day 3 of 12.7% versus 6.5% ( P = 0.002). In estimated glomerular filtration rate-based chronic kidney disease subgroups (30 to 39, 40 to 49, and 50 to 59 ml · min -1 · 1.73 m -2 ), the amino acid effect was similar (interaction P = 0.50). Finally, amino acid infusion decreased the occurrence of severe (stage 3) acute kidney injury (2.7% vs . 5.6%; relative risk 0.48; 95% CI, 0.24 to 0.98; P = 0.038).

Conclusions: Amino acid infusion protected chronic kidney disease patients undergoing cardiopulmonary bypass from developing acute kidney injury, with an absolute risk reduction of 7% and a number needed to treat of 14 in a cohort with a greater than 45% rate of acute kidney injury. Moreover, it delivered a greater than 50% relative risk reduction in severe acute kidney injury.

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氨基酸输注对心脏手术合并慢性肾病患者的肾脏保护作用：对保护试验的二次分析

背景：在 PROTECTION 试验中，静脉注射氨基酸（AA）减少了心肺旁路（CPB）心脏手术患者急性肾损伤（AKI）的发生。招募肾功能储备可能是提供这种保护的原因。然而，慢性肾脏病（CKD）患者的肾功能储备会减少，因此 AA 对这类患者的保护作用可能会减弱。因此，有必要对这类患者进行单独调查：我们将慢性肾脏病定义为估计肾小球滤过率（eGFR）：在 CKD 患者（n=812）中，与安慰剂相比，AA 能显著降低 AKI 的发生率（43.1% vs 50.3%；RR，0.86；95%CI，0.74 至 0.99；p=0.041；治疗所需数量 [NNT]=14 ），从基线到术后第三天，eGFR 的中位增加百分比为 12.7% vs 6.5% （p=0.002）。在基于 eGFR 的 CKD 亚组（30 至 39、40 至 49 和 50 至 59 mL-min-1-1.73 m-2）中，AA 的效果相似（交互作用 p=0.50）。最后，AA输注降低了严重（3期）AKI的发生率（2.7% vs. 5.6%; RR 0.48; 95%CI, 0.24 to 0.98; p=0.038）：结论：AA 输注可保护接受 CPB 的 CKD 患者免于发生 AKI，在 AKI 发生率大于 45% 的队列中，绝对风险降低了 7%，NNT 为 14。此外，它还能将严重 AKI 的相对风险降低 50%。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Anesthesiology 医学-麻醉学

CiteScore

10.40

自引率

5.70%

发文量

542

审稿时长

3-6 weeks

期刊介绍： With its establishment in 1940, Anesthesiology has emerged as a prominent leader in the field of anesthesiology, encompassing perioperative, critical care, and pain medicine. As the esteemed journal of the American Society of Anesthesiologists, Anesthesiology operates independently with full editorial freedom. Its distinguished Editorial Board, comprising renowned professionals from across the globe, drives the advancement of the specialty by presenting innovative research through immediate open access to select articles and granting free access to all published articles after a six-month period. Furthermore, Anesthesiology actively promotes groundbreaking studies through an influential press release program. The journal's unwavering commitment lies in the dissemination of exemplary work that enhances clinical practice and revolutionizes the practice of medicine within our discipline.