Post cardiac surgery acute kidney injury and the role of intravenous amino acids infusions

Acute kidney injury (AKI) is a well-established and serious complication associated with cardiovascular revascularization procedures, regardless of its severity. According to the 2023 annual report of the National Institute of Diabetes and Digestive and Kidney Diseases - United States Renal Data System, the incidence of cardiovascular disease-related AKI hospitalizations has been steadily increasing over the past decade. Coronary artery bypass grafting (CABG), on the other hand, remains one of the most frequently performed major surgical procedures in the United States, with an estimated 400,000 surgeries conducted annually. However, predicting the true incidence of acute kidney injury due to coronary artery bypass graft surgery (AKI-CABG) is challenging due to various factors. The reported incidence in literature is anywhere between 1% to 50%. Although healthcare teams employ various supportive measures to prevent its occurrence, a single universally effective preventive intervention for AKI-CABG remains elusive. This article focuses on a critical evaluation of the PROTECTION trial, a pioneering study evaluating the hypothesis that intravenous amino acid infusion would reduce the incidence of AKI-CABG using intravenous amino acid therapy (Isopuramin 10%, Baxter) in patients undergoing elective CABG surgery.