Intravenous Amino Acid Infusion May Reduce AKI Risk after Cardiac Surgery

Landoni G, Monaco F, Ti LK, et al. A Randomized Trial of Intravenous Amino Acids for Kidney Protection. N Engl J Med. 2024;391:687-698.

Ostermann M, Shaw AD. Amino Acid Infusion to Protect Kidney Function after Cardiac Surgery. N Engl J Med. 2024;391:759-760.

Acute kidney injury (AKI) is a significant complication following cardiac surgical procedures; the condition is due, in large part, to reduced renal perfusion. Intravenous amino acid infusions increase renal tissue perfusion, but data to support use of this intervention are limited.

This article reported a randomized trial (n = 3,511) conducted in adult patients cared for in 22 institutions. Amino acid infusion administered daily for 3 days following the surgical procedure was compared to crystalloid fluid infusion. AKI was diagnosed in 26.9% of the amino acid infusion group and 31.7% of the placebo group. Severe AKI risk was significantly reduced in the amino acid group.

The authors concluded that amino acid infusion reduced AKI risk.

In the editorial that accompanied the article, Osterman and Shaw noted that there were significant differences in management of included patients that could have introduced unintentional bias in the results. Because of these inconsistencies, they encouraged clinicians to interpret these results with caution.