Key result
Intraoperative amino acid infusion did not significantly reduce the incidence of postoperative acute kidney injury compared to control in patients undergoing open abdominal aortic aneurysm repair (24.7% vs. 25.3%, HR 0.86).
Why the study?
Postoperative AKI incidence after open AAA repair is elevated, and amino acid infusion increases renal blood flow, prompting the hypothesis that intraoperative infusion reduces postoperative AKI.
Does intraoperative amino acid infusion reduce postoperative acute kidney injury in patients undergoing open abdominal aortic aneurysm repair?
Cohort (n=696)
No
Does intraoperative amino acid infusion reduce postoperative acute kidney injury in patients undergoing open abdominal aortic aneurysm repair?
Hazard Ratio: 0.86 (95% CI 0.67–1.11)
Absolute Event Rate: 24.7% vs 25.3%
p-value: p=0.24
Intraoperative amino acid infusion during open abdominal aortic aneurysm repair did not significantly reduce the incidence of postoperative acute kidney injury.
Background: The incidence of acute kidney injury (AKI) after open abdominal aortic aneurysm (AAA) repair is reportedly higher than the incidence after general surgery. Amino acid infusion has been shown to increase renal blood flow, thus protecting the kidneys. Therefore, we hypothesized that intraoperative amino acid infusion, which was used to maintain body temperature, is associated with a lower incidence of postoperative AKI. The aim of this study was to validate this hypothesis. Methods: In this retrospective, observational, single-center cohort study, we included patients who underwent open AAA repair between January 2007 and April 2019. Perioperative data were abstracted from medical records. The primary outcome was AKI diagnosed according to Kidney Disease: Improving Global Outcomes criteria. Secondary outcomes were creatinine-AKI diagnosed based on serum creatinine alone and postoperative serum creatinine trajectory. A Fine and Gray proportional hazards regression analysis was conducted to examine the relationship between amino acid infusion and AKI. Similarly, multivariable logistic regression was performed for creatinine-AKI. Postoperative serum creatinine trajectory was assessed using a multivariable non-linear regression model with the Huber-White method.Results: Of 696 patients, 310 patients received an amino acid infusion. Most patients received an amino acid infusion of 20 g. The amino acid group had a lower prevalence of AKI (24.7% vs. 25.3%; adjusted Hazard Ratio (HR)=0.86; 95% CI, 0.67–1.11; P=0.24) and creatinine-AKI (23.5% vs. 19.2%; adjusted odds ratio (OR)=0.84; 95% CI, 0.50–1.43; P=0.52) than the control group, but the differences were not statistically significant. Postoperative serum creatinine levels were significantly lower in the amino acid infusion group on postoperative days 5 and 6.Conclusions: Intraoperative amino acid infusion has a tendency to reduce the incidence of postoperative AKI among patients undergoing open AAA repair. However, we could not show a statistically significant difference.Trial registration: UMIN000038527, 09/11/2019
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Kazawa et al. (2022) conducted a cohort in Abdominal aortic aneurysm (n=696). Intraoperative amino acid infusion vs. No amino acid infusion was evaluated on Acute kidney injury (AKI) according to KDIGO criteria (HR 0.86, 95% CI 0.67-1.11, p=0.24). Intraoperative amino acid infusion did not significantly reduce the incidence of postoperative acute kidney injury compared to control in patients undergoing open abdominal aortic aneurysm repair (24.7% vs. 25.3%, HR 0.86).
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