Jiang Wei, Shi Keran, Shao Jun, Song Lin, Shi Ying, Wang Haoran, Zhou Lulun, Li Luanluan, Feng Yunfan, Yu Jiangquan, Zheng Ruiqiang
Department of Critical Care Medicine, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou 225001, China; Department of Critical Care Medicine, Northern Jiangsu People's Hospital, Yangzhou 225001, China.
Department of Critical Care Medicine, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou 225001, China; Department of Critical Care Medicine, Northern Jiangsu People's Hospital, Yangzhou 225001, China.
J Crit Care. 2025 Feb;85:154937. doi: 10.1016/j.jcrc.2024.154937. Epub 2024 Oct 23.
Acute kidney injury (AKI) is a common complication in critically ill and cardiac surgery patients. Intravenous amino acids can increase renal perfusion and replenish renal functional reserves. However, the exact therapeutic efficacy of intravenous amino acids in reducing the incidence of AKI remains uncertain. Therefore, this study aims to comprehensively review the existing evidence to assess the potential of intravenous amino acids in kidney protection.
EMBASE, PubMed, MEDLINE, and the Cochrane Library were searched for randomized controlled trials published on or before July 2, 2024, that examined the relationship between Intravenous amino acids and renal function. We extracted population characteristics and outcome variables related to renal function from randomized controlled trials comparing intravenous amino acid supplementation with no supplementation. We assessed this evidence using the Risk of Bias 2 (RoB2) tool for randomized controlled trials. Data were synthesized using a random-effects model.
This review included 7 randomized controlled trials with a total of 505 patients. The results showed that compared with the control group, intravenous amino acid administration significantly reduced the incidence of AKI (RR: 0.81, 95 % CI: 0.68-0.97, P = 0.02) and increased urine output (MD: 308.87, 95 % CI: 168.68-449.06, P < 0.0001). However, intravenous amino acids did not reduce mortality or the incidence of kidney replacement therapy, with no statistical difference in 30-day mortality (RR: 0.93, 95 % CI: 0.65-1.34, P = 0.71), 90-day mortality (RR:1.00, 95 % CI: 0.77-1.29, P = 0.98), or need for kidney replacement therapy (RR: 0.92, 95 % CI: 0.41-2.06, P = 0.83). Subgroup analysis suggested that, regardless of sample size, intravenous amino acid administration reduced the incidence of AKI and was particularly significant in patients undergoing cardiac and major vascular surgery. Furthermore, intraoperative intravenous amino acid therapy demonstrated a significant reduction in the incidence of AKI compared to postoperative administration.
Intravenous amino acids protect renal function in patients at high risk of AKI, particularly after cardiac surgery. It reduces the incidence of AKI and increases urine output, but has no significant effect on KRT and mortality.
急性肾损伤（AKI）是危重症患者和心脏手术患者常见的并发症。静脉输注氨基酸可增加肾灌注并补充肾功能储备。然而，静脉输注氨基酸在降低AKI发生率方面的确切治疗效果仍不确定。因此，本研究旨在全面回顾现有证据，以评估静脉输注氨基酸在肾脏保护方面的潜力。
检索EMBASE、PubMed、MEDLINE和Cochrane图书馆，查找2024年7月2日或之前发表的关于静脉输注氨基酸与肾功能关系的随机对照试验。我们从比较静脉补充氨基酸与不补充氨基酸的随机对照试验中提取了与肾功能相关的人群特征和结局变量。我们使用随机对照试验的偏倚风险2（RoB2）工具评估了这一证据。数据采用随机效应模型进行综合分析。
本综述纳入了7项随机对照试验，共505例患者。结果显示，与对照组相比，静脉输注氨基酸显著降低了AKI的发生率（RR：0.81，95%CI：0.68 - 0.97，P = 0.02），并增加了尿量（MD：308.87，95%CI：168.68 - 449.06，P < 0.0001）。然而，静脉输注氨基酸并未降低死亡率或肾脏替代治疗的发生率，30天死亡率（RR：0.93，95%CI：0.65 - 1.34，P = 0.71）、90天死亡率（RR：1.00，95%CI：0.77 - 1.29，P = 0.98）或肾脏替代治疗需求（RR：?0.92，95%CI：0.41 - 2.06，P = 0.83）均无统计学差异。亚组分析表明，无论样本量大小，静脉输注氨基酸均可降低AKI的发生率，在接受心脏和大血管手术的患者中尤为显著。此外，与术后给药相比，术中静脉输注氨基酸治疗可显著降低AKI的发生率。
静脉输注氨基酸可保护AKI高危患者的肾功能，尤其是在心脏手术后。它可降低AKI的发生率并增加尿量，但对肾脏替代治疗和死亡率无显著影响。
