Annals of medicine and surgery (2012) · 2026
Trial sequential analysis of the efficacy of amino acid and protein therapy in preventing cardiac surgery-associated acute kidney injury: a systematic review and meta-analysis.
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Odat Ramez M, Aldamen Ali O, Hussein Ayham Mohammad, Wshahe Maram Salem, Mistarihi Tariq Eyad, Khasawneh Yumna Mohammad, Mohammad Raja' Awni, Abed Ahmad Nedal, Alzamil Bushra Moutaz, Al Thaher Omar Tariq, Momani Aws Emad, Khalefa Basma Badrawy, Yadav Rukesh
Аннотация
INTRODUCTION: Acute kidney injury (AKI) is a common complication after cardiac surgery, with varying severity and outcomes. Despite studies on corticosteroids, remote ischemic preconditioning, and amino acid therapies like glutamate, results have remained inconsistent. This review aims to clarify the therapeutic role of intravenous amino acids in improving outcomes of cardiac surgery-related AKI.
METHODS: This systematic review followed PRISMA guidelines, analyzing studies on intravenous amino acids to prevent cardiac surgery-associated AKI. Databases were searched using MeSH terms, and strict inclusion criteria were applied. Data extraction, risk-of-bias assessment, and meta-analysis were conducted with standardized tools, including RevMan and TSA, to ensure reliability and statistical validity.
RESULTS: This meta-analysis included eight studies (seven RCTs and one cohort) evaluating amino acid/protein administration, with over 5000 participants per group. Results showed a non-significant trend toward reduced AKI risk (RR = 0.80, 95% CI: 0.63-1.02; P = 0.07), a significant reduction in kidney replacement therapy (RR = 0.66, 95% CI: 0.40-1.08; P = 0.07), and shorter hospital stays (SMD = -0.62). No significant effects were observed for mortality, stroke, arrhythmias, or dialysis. Heterogeneity varied, with the highest for hospital stays (I 2 = 95%).
CONCLUSION: Intraoperative amino acid/protein administration may reduce the risk of AKI and the need for renal replacement therapy, although this intervention appears to have limited impact on mortality or other complications. The observation of shorter hospital stays is promising, but further research is needed to standardize protocols and understand the underlying mechanisms.
METHODS: This systematic review followed PRISMA guidelines, analyzing studies on intravenous amino acids to prevent cardiac surgery-associated AKI. Databases were searched using MeSH terms, and strict inclusion criteria were applied. Data extraction, risk-of-bias assessment, and meta-analysis were conducted with standardized tools, including RevMan and TSA, to ensure reliability and statistical validity.
RESULTS: This meta-analysis included eight studies (seven RCTs and one cohort) evaluating amino acid/protein administration, with over 5000 participants per group. Results showed a non-significant trend toward reduced AKI risk (RR = 0.80, 95% CI: 0.63-1.02; P = 0.07), a significant reduction in kidney replacement therapy (RR = 0.66, 95% CI: 0.40-1.08; P = 0.07), and shorter hospital stays (SMD = -0.62). No significant effects were observed for mortality, stroke, arrhythmias, or dialysis. Heterogeneity varied, with the highest for hospital stays (I 2 = 95%).
CONCLUSION: Intraoperative amino acid/protein administration may reduce the risk of AKI and the need for renal replacement therapy, although this intervention appears to have limited impact on mortality or other complications. The observation of shorter hospital stays is promising, but further research is needed to standardize protocols and understand the underlying mechanisms.