Intravenous Amino Acid Therapy for Kidney Protection in Cardiac Surgery.
Status:
Recruiting
Trial end date:
2022-07-01
Target enrollment:
Participant gender:
Summary
To date, no pharmacological agents are proven efficacious in treating perioperative AKI.
There is a strong biological rationale for the administration of amino acid in the management
of patients at risk of AKI with increases in renal blood flow and GFR of 25 to 60% for
several hours after the administration of amino acids (Woods LL 1993) mediated by a afferent
arteriolar dilation.(Meyer TW 1983) Moreover, animal models have demonstrated that an
increase in renal blood flow in response to a short-term amino acid infusion can protect the
kidney from acute ischemic insults. Finally, these nephro-protective effects are preserved in
critical illness. Cardiac surgery appears to be the best setting to test the likely
beneficial renal effects of amino acid because of pathophysiological principles and the
ability to intervene before the injury has begun. Although the etiology of AKI in cardiac
surgery is multifactorial, renal hypoperfusion is believed to play a major role in this
development by decreasing renal perfusion through a reduction in renal blood flow and through
the activation of the sympathetic nervous system and the renin-angiotensin system with
afferent arteriolar vasoconstriction. In this setting, a global increase in renal blood flow
by means of Amino Acid therapy appears a logical and promising intervention.
The primary aim of the study is to determine whether providing continuous infusion of a
balanced mixture of amino acids, compared to placebo (balanced crystalloid solution), reduces
the incidence of acute kidney injury (AKI) in patients scheduled for cardiac surgery defined
as KDIGO stage 1 or greater during hospital stay.