Journal of Clinical Practice · Published 2026-04-03 · DOI 10.17816/clinpract688428
BACKGROUND: Acute kidney injury is one of the most common complications after cardiac surgery with cardiopulmonary bypass, with the least favorable prognosis. Despite a variety of pharmacological and non-pharmacological interventions, there is no universally effective strategy for preventing acute kidney injury. One promising nephroprotective approach is activating renal functional reserve via amino acid infusion. AIM: The work aimed to assess the nephroprotective potential of perioperative intravenous infusion of a balanced amino acid solution in patients after cardiac surgery with cardiopulmonary bypass. METHODS: A randomized, double-blind, placebo-controlled, single-center study with pooled post hoc analysis included 260 patients aged 18–75 years who underwent elective cardiac surgery with cardiopulmonary bypass. The treatment group (n=130) received a 10% amino acid solution (2 g/kg/day for 24 hours); the control group (n=130) received an equal amount of balanced crystalloid solution. The primary endpoint was the estimated glomerular filtration rate according to the CKD-EPI equation. Secondary endpoints included the incidence, severity, and duration of acute kidney injury; urine output; diuretic use; duration of renal replacement therapy; and length of ICU/hospital stay. The statistical analysis included the Mann–Whitney U test, z-test, and Holm–Bonferroni correction. RESULTS: Amino acid infusion significantly improved renal function, with a median glomerular filtration rate of 79 [61; 93] vs 72 [55; 86] mL/min/1.73 m2 (pHolm 0.0005). The incidence of acute kidney injury decreased from 29.2% to 18.5% (pHolm 0.042); the incidence of severe acute kidney injury from 17.7% to 6.2% (pHolm 0.0123); and the duration of acute kidney injury from 5 [4; 6] to 3 [3; 4] days (pHolm 0.0024). Serum creatinine and urea levels were lower, and urine output was higher in the treatment group. CONCLUSION: Perioperative amino acid infusion safely reduces the incidence and severity of acute kidney injury and improves renal function parameters after cardiac surgery with cardiopulmonary bypass, supporting its use as an early nephroprotective strategy.
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