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

医学 肾脏疾病 肾功能 急性肾损伤 安慰剂 内科学 肾脏替代疗法 胃肠病学 泌尿科 病理 替代医学
作者
Martina Baiardo Redaelli,Fabrizio Monaco,Nikola Bradić,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
出处
期刊:Anesthesiology [Lippincott Williams & Wilkins]
被引量:2
标识
DOI:10.1097/aln.0000000000005336
摘要

Background: In the PROTECTION trial, intravenous amino acids (AA) decreased the occurrence of acute kidney injury (AKI) in cardiac surgery patients with cardiopulmonary bypass (CPB). Recruitment of renal functional reserve may be responsible for such protection. However, patients with chronic kidney disease (CKD) have diminished renal functional reserve, and AA may be less protective in such patients. Thus, a separate investigation of such patients is warranted. Methods: We defined CKD as an estimated glomerular filtration rate (eGFR)<60 mL·min -1 ·1.73 m -2 and patients with eGFR≥60 mL·min -1 ·1.73 m -2 served as controls. The primary outcome was the occurrence of AKI. Secondary outcomes included severity of AKI, need for and duration of renal replacement therapy, and all-cause mortality. Results: Among CKD patients (n=812), compared with placebo, AA significantly decreased the rate of AKI (43.1% vs 50.3%; RR, 0.86; 95%CI, 0.74 to 0.99; p=0.041; number needed to treat [NNT]=14) with a median percentage increase in eGFR from baseline to postoperative day three of 12.7% vs. 6.5% (p=0.002). In eGFR-based CKD subgroups (30 to 39, 40 to 49, and 50 to 59 mL·min -1 ·1.73 m -2 ) the AA effect was similar (interaction p=0.50). Finally, AA infusion decreased the occurrence of severe (stage 3) AKI (2.7% vs. 5.6%; RR 0.48; 95%CI, 0.24 to 0.98; p=0.038). Conclusions: AA infusion protected CKD patients undergoing CPB from developing AKI, with an absolute risk reduction of 7% and a NNT of 14 in a cohort with a >45% rate of AKI. Moreover, it delivered a >50% relative risk reduction in severe AKI.
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