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Purpose <p>Acute kidney injury (AKI) is a common complication after cardiac surgery and is associated with increased morbidity and mortality. Intravenous amino acids (AA) infusion reduces postoperative AKI. Given the high prevalence of patients with diabetes and their increased susceptibility to renal injury, this study aimed to assess whether the renal-protective effect of AA infusion is maintained in this population.</p> Methods <p>This post-hoc subgroup analysis examined patients with diabetes included in the multinational, double-blind, randomized, placebo-controlled PROTECTION trial. Participants were randomized to receive a continuous intravenous infusion of AA (2&#xa0;g/kg of the ideal body weight per day; up to 72&#xa0;h) or placebo during the perioperative period of cardiac surgery.</p> Results <p>Among 644 patients with diabetes (AA <i>n</i> = 309; placebo <i>n</i> = 335), the incidence of any-stage AKI was 43.3% in the AA group versus 47.8% in the placebo group, with no significant interaction observed compared to patients without diabetes (interaction <i>p</i> = 0.82). Similarly, stage 3 AKI occurred in 2.3% of patients in AA group versus 4.8% in the placebo group, with no interaction detected (interaction <i>p</i> = 0.65).</p> Conclusion <p>The beneficial effect of perioperative AA infusion has similar magnitude and direction among patients with or without diabetes. These findings support the use of AA infusion as a renal-protective strategy for all patients undergoing cardiac surgery.</p> Trial registration number <p>ClinicalTrials.gov NCT03709264 – registered on October 17th, 2018.</p>

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Diabetes does not modify the renal-protective effect of intravenous amino acids infusion after cardiac surgery

  • 期刊论文

  • 发表日期：

    2026年1月9日

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  • Michela Consonni,
  • Stefano Fresilli,
  • Yuki Kotani,
  • Eugenio Garofalo,
  • Nikola Bradic,
  • Anna Mara Scandroglio,
  • Lian Kah Ti,
  • Marco Comis,
  • Alessandro Oriani,
  • Antonio Pisano,
  • Alessandro Belletti,
  • Fabio Guarracino,
  • Rosario Losiggio,
  • Martina Baiardo Redaelli,
  • Domenico Pontillo,
  • Cristina Arangino,
  • Alessandro Pruna,
  • Francesco Federici,
  • Filippo D’Amico,
  • Simona Silvetti,
  • Rosa Labanca,
  • Federica Ferrod,
  • Giuseppe Pittella,
  • Federica Corbo,
  • Marco Ranucci,
  • Andrea Cortegiani,
  • Gianluca Paternoster,
  • Tiziana Bove,
  • Federico Longhini,
  • Fabrizio Monaco,
  • Alberto Zangrillo,
  • Lorenzo Piemonti

摘要

Purpose

Acute kidney injury (AKI) is a common complication after cardiac surgery and is associated with increased morbidity and mortality. Intravenous amino acids (AA) infusion reduces postoperative AKI. Given the high prevalence of patients with diabetes and their increased susceptibility to renal injury, this study aimed to assess whether the renal-protective effect of AA infusion is maintained in this population.

Methods

This post-hoc subgroup analysis examined patients with diabetes included in the multinational, double-blind, randomized, placebo-controlled PROTECTION trial. Participants were randomized to receive a continuous intravenous infusion of AA (2 g/kg of the ideal body weight per day; up to 72 h) or placebo during the perioperative period of cardiac surgery.

Results

Among 644 patients with diabetes (AA n = 309; placebo n = 335), the incidence of any-stage AKI was 43.3% in the AA group versus 47.8% in the placebo group, with no significant interaction observed compared to patients without diabetes (interaction p = 0.82). Similarly, stage 3 AKI occurred in 2.3% of patients in AA group versus 4.8% in the placebo group, with no interaction detected (interaction p = 0.65).

Conclusion

The beneficial effect of perioperative AA infusion has similar magnitude and direction among patients with or without diabetes. These findings support the use of AA infusion as a renal-protective strategy for all patients undergoing cardiac surgery.

Trial registration number

ClinicalTrials.gov NCT03709264 – registered on October 17th, 2018.