Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
J Cardiothorac Vasc Anesth. 2024 Dec;38(12):3076-3085. doi: 10.1053/j.jvca.2024.08.033. Epub 2024 Aug 22.
Acute kidney injury (AKI) is a common perioperative complication. To date, no single intervention has been proven effective for AKI prevention in this setting. However, intravenous amino acids (AA) administration may recruit renal functional reserve and, thereby, attenuate the perioperative loss of the glomerular filtration rate.
We performed a meta-analysis to assess the efficacy of AA infusion for perioperative renal functional protection.
We performed a meta-analysis of controlled studies in perioperative patients evaluating intravenous AA infusion versus any comparator.
The primary outcome was AKI at longest follow-up. We performed a random effects meta-analysis on the relative risk (RR) scale to assess the effect of AA infusion. We used a Bayesian approach to estimate the probability of benefit (RR < 1) for the primary outcome. Secondary outcomes included renal replacement therapy, serum creatinine, and estimated glomerular filtration rate. Tertiary outcomes included mechanical ventilation duration, intensive care unit and hospital length of stay and mortality (PROSPERO: CRD42024547225).
We identified 15 studies (14 randomized controlled trials and 1 prospective before-after study) reporting at least one outcome of interest (4,544 patients), with 6 studies (4,084 patients) reporting the primary outcome. AKI occurred 504 of 2,041 (24.7%) in AA patients versus 614 of 2,041 (30.1%) in controls (RR, 0.66; 95% confidence interval, 0.47-0.94; I = 50%; p = 0.02), which corresponded with a 99.1% probability of AKI reduction with AA. Moreover, consistent with these findings, AA decreased serum creatinine and hospital length of stay and increased the estimated glomerular filtration rate.
This meta-analysis suggests that AA administration likely decreased the perioperative incidence of AKI.
急性肾损伤（AKI）是一种常见的围手术期并发症。迄今为止，尚无单一干预措施被证明对该情况下的 AKI 预防有效。然而，静脉内氨基酸（AA）的给予可能会募集肾脏功能储备，从而减轻围手术期肾小球滤过率的丢失。
我们进行了一项荟萃分析，以评估 AA 输注在围手术期肾功能保护中的疗效。
我们对评估静脉内 AA 输注与任何对照比较的围手术期患者的对照研究进行了荟萃分析。
主要结局是最长随访时的 AKI。我们在相对风险（RR）尺度上进行了随机效应荟萃分析，以评估 AA 输注的效果。我们使用贝叶斯方法来估计主要结局的获益概率（RR<1）。次要结局包括肾脏替代治疗、血清肌酐和估算肾小球滤过率。次要结局包括机械通气时间、重症监护病房和住院时间以及死亡率（PROSPERO：CRD42024547225）。
我们确定了 15 项研究（14 项随机对照试验和 1 项前瞻性前后对照研究），报告了至少一个感兴趣的结局（4544 例患者），其中 6 项研究（4084 例患者）报告了主要结局。AA 组的 2041 例患者中有 504 例（24.7%）发生 AKI，对照组的 2041 例患者中有 614 例（30.1%）（RR，0.66；95%置信区间，0.47-0.94；I=50%；p=0.02），这与 AA 降低 AKI 的概率为 99.1%一致。此外，与这些发现一致，AA 降低了血清肌酐和住院时间，增加了估算肾小球滤过率。
这项荟萃分析表明，AA 给药可能降低了围手术期 AKI 的发生率。
