Impact of Cardiopulmonary Bypass Duration on the Renal Effects of Amino Acids Infusion in Cardiac Surgery Patients.

IF 2.3 4区医学 Q2 ANESTHESIOLOGY

Journal of cardiothoracic and vascular anesthesia Pub Date : 2025-06-02 DOI:10.1053/j.jvca.2025.05.050

Domenico Pontillo, Lisa Q Rong, Alessandro Pruna, Antonio Pisano, Fabrizio Monaco, Andrea Bruni, Martina Baiardo Redaelli, Lian Kah Ti, Alessandro Belletti, Nikola Bradic, Cristiano Massaro, Gaia Barucco, Cristina Viscido, Rosario Losiggio, Francesco Federici, Marilena Marmiere, Simona Silvetti, Cristiano Marchetti, Monica Carmosino, Marco Manazza, Federico Mattia Oliva, Andrea Cortegiani, Fabio Guarracino, Marco Ranucci, Gianluca Paternoster, Giovanni Landoni, Alberto Zangrillo, Mario F L Gaudino, Rinaldo Bellomo

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Abstract

Objective: To test whether the duration of cardiopulmonary bypass (CPB) affects the nephroprotective effect of amino acids (AA) infusion in decreasing the occurrence of acute kidney injury (AKI) among cardiac surgery patients.

Design: A post hoc study of the PROTECTION multicenter randomized double-blind placebo-controlled trial aiming to assess the effect of CPB duration on the differential impact of AA infusion on both the absolute and relative risk reduction in AKI incidence by comparing medians of CPB duration and CPB duration as a continuous variable.

Setting: International, multicenter.

Participants: The entire population of the PROTECTION trial, comprising 3511 adult patients undergoing cardiac surgery with CPB.

Interventions: Intravenous AA infusion at a dosage of 2 g/kg/day, up to a maximum of 100 g/day.

Measurements and main results: Compared with patients with CPB duration above the median (prolonged [P]-CPB group), patients with CPB duration below the median (brief [B]-CPB group) had a significantly lower incidence of AKI (23% [n/N =391/1716] vs 36% [n/N = 617/1723]; relative risk [RR], 0.64; 95% confidence interval [CI], 0.57-0.71; p <0.001). However, in the P-CPB group, AA infusion achieved an 8% absolute risk reduction (32% vs 40%) and a 0.79 RR reduction (95% CI, 0.70-0.90; p < 0.001; number needed to treat, 14). Moreover, AA also decreased the occurrence of AKI stage 3 (2.2% [n = 19] vs 5.0% [n = 43]; RR, 0.45; 95% CI, 0.26-0.76; p < 0.001) with a >95% probability of this effect being significantly greater in the P-CPB group compared to the B-CPB group.

Conclusions: Cardiac surgery patients with prolonged CPB exposure had a significantly higher incidence of AKI. Notably, the P-CPB group received a greater benefit from AA therapy with an absolute risk and relative risk reduction of both any and severe AKI compared with the B-CPB group. Patients with prolonged CPB may be the specific targets of future studies.

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体外循环时间对心脏手术患者输注氨基酸对肾脏影响的影响。

目的：探讨体外循环（CPB）时间对氨基酸（AA）输注降低心脏手术患者急性肾损伤（AKI）发生的肾保护作用的影响。设计：一项保护性多中心随机双盲安慰剂对照试验的事后研究，旨在通过比较CPB持续时间和CPB持续时间的中位数作为连续变量，评估CPB持续时间对AA输注对AKI发生率绝对和相对风险降低的差异影响的影响。环境：国际化、多中心。受试者：保护试验的全部人群，包括3511例接受CPB心脏手术的成年患者。干预措施：静脉滴注AA，剂量为2g /kg/天，最高可达100g /天。测量和主要结果：与CPB持续时间高于中位数（延长[P]-CPB组）的患者相比，CPB持续时间低于中位数（短暂[B]-CPB组）的患者AKI发生率显著降低(23% [n/ n =391/1716] vs 36% [n/ n = 617/1723]；相对危险度[RR]， 0.64；95%置信区间[CI]， 0.57-0.71；p - cpb组与B-CPB组相比，95%的概率显著高于p - cpb组。结论：长期暴露于CPB的心脏手术患者AKI发生率显著增高。值得注意的是，与B-CPB组相比，P-CPB组从AA治疗中获益更大，任何和严重AKI的绝对风险和相对风险都降低了。长期CPB患者可能是未来研究的具体目标。

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

Journal of cardiothoracic and vascular anesthesia 医学-呼吸系统

CiteScore

4.80

自引率

17.90%

发文量

606

审稿时长

37 days

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.