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Cited by 232Acute Kidney Injury ResearchClinical Nutrition and GastroenterologyChronic Kidney Disease and Diabetes

Intravenous amino acid therapy for kidney function in critically ill patients: a randomized controlled trial

Doig, Gordon S., Simpson, Fiona, Bellomo, Rinaldo, Heighes, Philippa T., Sweetman, Elizabeth A., Chesher, Douglas, Pollock, Carol, Davies, Andrew +3 more·2015·Intensive Care Medicine
DOI 10.1007/s00134-015-3827-9
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Abstract

Importance Acute kidney injury (AKI) is characterized by severe loss of glomerular filtration rate (GFR) and is associated with a prolonged intensive care unit (ICU) stay and increased risk of death. No interventions have yet been shown to prevent AKI or preserve GFR in critically ill patients. Evidence from mammalian physiology and small clinical trials suggests higher amino acid intake may protect the kidney from ischemic insults and thus may preserve GFR during critical illness. Objective To determine whether amino acid therapy, achieved through daily intravenous (IV) supplementation with standard amino acids, preserves kidney function in critically ill patients. Design, setting, and participants Multicenter, phase II, randomized clinical trial conducted between December 2010 and February 2013 in the ICUs of 16 community and tertiary hospitals in Australia and New Zealand. Participants were adult critically ill patients expected to remain in the study ICU for longer than 2 days. Interventions Random allocation to receive a daily supplement of up to 100 g of IV amino acids or standard care. Main outcomes and measures Duration of renal dysfunction (primary outcome); estimated GFR (eGFR) derived from creatinine; eGFR derived from cystatin C; urinary output; renal replacement therapy (RRT) use; fluid balance and other measures of renal function. Results 474 patients were enrolled and randomized (235 to standard care, 239 to IV amino acid therapy). At time of enrollment, patients allocated to receive amino acid therapy had higher APACHE II scores (20.2 ± 6.8 vs. 21.7 ± 7.6, P = 0.02) and more patients had pre-existing renal dysfunction (29/235 vs. 44/239, P = 0.07). Duration of renal dysfunction after enrollment did not differ between groups (mean difference 0.21 AKI days per 10 patient ICU days, 95 % CI -0.27 to 1.04, P = 0.45). Amino acid therapy significantly improved eGFR (treatment group × time interaction, P = 0.004), with an early peak difference of 7.7 mL/min/1.73 m(2) (95 % CI 1.0-14.5 mL/min/1.73 m(2), P = 0.02) on study day 4. Daily urine output was also significantly increased (+300 mL/day, 95 % CI 145-455 mL, P = 0.0002). There was a trend towards increased RRT use in patients receiving amino acid therapy (13/235 vs. 25/239, P = 0.062); however, this trend was not present after controlling for baseline imbalance (P = 0.21). Conclusion and relevance Treatment with a daily IV supplement of standard amino acids did not alter our primary outcome, duration of renal dysfunction. Trial registration anzctr.org.au Identifier: ACTRN12609001015235.

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  • Looijaard et al. showed that sarcopenic ICU patients benefit more from protein intake >1.2 g/kg per day.

    “Looijaard et al. (168) showed that sarcopenic ICU patients benefit more from protein intake > 1.2 g/kg per day.”

    From ESPEN guideline on clinical nutrition in the intensive care unit. (2019) · cites this paper as [168]

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Authors
Doig, G. S., Simpson, F., Bellomo, R., Heighes, P. T., Sweetman, E. A., Chesher, D., Pollock, C., Davies, A., Botha, J., Harrigan, P., & Reade, M. C.
Affiliations
  • The University of Sydney (AU)
  • Monash University (AU)
  • John Hunter Hospital (AU)
  • The University of Queensland (AU)
Corresponding author
Doig, Gordon S.
ORCID
Venue
Intensive Care Medicine
Publisher
Springer Science and Business Media LLC
Published
2015-04-30
Volume
41
Issue
7
Pages
1197-1208
ISSN
  • 0342-4642 (ISSN-L)
  • 1432-1238
DOI
10.1007/s00134-015-3827-9
OpenAlex
W2010536286
Cited by
232
References
40
Citations by year
2026: 11 · 2025: 24 · 2024: 34 · 2023: 17 · 2022: 16 · 2021: 20 · 2020: 18 · 2019: 28 · 2018: 30 · 2017: 21 · 2016: 9 · 2015: 4
FWCI
18.49
Type
journal article
Language
en
Open access
closed
Licence
www.springer.com/tdm (tdm)
Locations
  • Intensive Care Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
Funders
National Health and Medical Research Council (632614)
Topics
  • Health Sciences › Medicine › Nephrology › Acute Kidney Injury Research
  • Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
  • Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
Keywords
intravenous amino acids, acute kidney injury, critically ill patients, renal function preservation, estimated glomerular filtration rate, cystatin C, renal replacement therapy, fluid balance, urine output, intensive care unit, APACHE II score, dietary supplementation, ICU length of stay
MeSH terms
Aged, Amino Acids, Creatinine, Female, Glomerular Filtration Rate, Humans, Intensive Care Units, Male, Middle Aged, Critical Illness, Cystatin C, Acute Kidney Injury

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