EFFECTIVENESS OF AMINO ACID SUPPLEMENTATION IN PREVENTING ACUTE KIDNEY INJURY FOLLOWING CARDIAC SURGERY: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

7 Feb 2025 12 a.m. 12 a.m.

WCN25-AB-1885, Poster Board= FRI-053

Introduction:

Acute kidney injury (AKI) is a common complication after cardiac surgery, associated with increased morbidity, prolonged hospitalization, and higher mortality rates. Previous studies have suggested that amino acid supplementation may reduce the incidence of AKI by enhancing renal blood flow and glomerular filtration rate (GFR). However, evidence remains inconclusive regarding the overall benefit and impact on secondary outcomes. Hence, we aimed to assess the effectiveness of perioperative amino acid supplementation in preventing AKI and other related complications following cardiac surgery.

Methods:

PubMed, Embase, and Cochrane databases were systematically searched for randomized controlled trials (RCTs) comparing amino acids versus standard care in preventing cardiac surgery-associated acute kidney injury. We used the Mantel-Haenszel (MH) model of random effects to calculate pooled risk ratios (RRs) for binary endpoints with 95% confidence intervals (CIs). The primary outcome was the risk of AKI, defined by the Kidney Disease Improving Global Outcomes (KDIGO) criteria. Secondary outcomes included 30-day mortality, renal replacement therapy (RRT) requirement, postoperative stroke, and atrial and ventricular fibrillation. Heterogeneity was assessed using the I² statistic. Statistical analyses were performed using R version 4.4.2, with significance determined at a p-value < 0.05.

Results:

This meta-analysis included five randomized controlled trials (RCTs) comprising 4,501 patients who underwent cardiac surgery. Amino acid supplementation significantly reduced the risk of AKI compared to the control group (RR = 0.80; 95% CI 0.66–0.97; p = 0.026; I² = 28%). However, there were no significant differences in 30-day mortality (RR = 1.03; 95% CI 0.36–2.93; p = 0.959; I² = 42%), RRT requirement (RR = 0.78; 95% CI 0.36–1.71; p = 0.537; I² = 22%), postoperative stroke (RR = 1.05; 95% CI 0.40–2.78; p = 0.918; I² = 34%), or postoperative atrial (RR = 1.00; 95% CI 0.88–1.15; p = 0.961; I² = 38%) and ventricular fibrillation (RR = 1.81; 95% CI 0.84–3.90; p = 0.132; I² = 0%).

Forest plot for post-operative incidence of AKI.

Forest plot for post-operative 30-day mortality.

Forest plot for post-operative need of renal replacement therapy.

Conclusions:

Amino acid supplementation reduces AKI risk in cardiac surgery patients but does not significantly impact mortality, RRT, or other postoperative complications. More extensive trials are needed to confirm these findings.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.