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Renal Replacement Therapy / Acute Kidney Injury · observational study with target trial emulation
Renal Failure · June 23, 2026
The material analysed did not support any firm read.
This multicenter observational study emulating a target trial found no significant association between postoperative amino acid therapy (>21 g daily for 2 days) and acute kidney injury after aortic surgery. An exploratory subgroup analysis suggested potential benefit in patients aged ≥65 years, but this hypothesis-generating finding requires prospective validation.
Multicenter observational study with target trial emulation. Patients undergoing aortic surgery from the Aortic Surgery Database of the Shanghai Hospital Development Center. Intervention: Daily amino acid dose of >21 g during the first 2 postoperative days. Compared with: Not receiving amino acid therapy above this threshold. n = 1,816. Shanghai Hospital Development Center (China).
No significant association between amino acid exposure and AKI incidence (OR = 0.96, 95% CI: 0.79-1.17, p = 0.70) No significant association with 30-day mortality (OR = 1.54, 95% CI: 0.68-3.50, p = 0.30) In patients aged ≥65 years, amino acid exposure associated with lower AKI risk (OR = 0.71, 95% CI: 0.53-0.95, p = 0.02)
No significant association with 30-day mortality (OR = 1.54, 95% CI: 0.68-3.50, p = 0.30) Overall AKI incidence was 37.8% (n = 686) and 30-day mortality was 1.6% (n = 29)
This study does not support routine use of amino acid therapy (>21 g daily for 2 days postoperatively) to prevent AKI after aortic surgery. The exploratory subgroup finding in older patients is explicitly noted by the authors as requiring confirmation and should not guide current practice.
Observational study with target trial emulation found no significant association between amino acid therapy and AKI, though hypothesis-generating subgroup signal in older patients.
As stated by the source record.
Quoted from the source exactly as published.
This study does not support routine use of amino acid therapy (>21 g daily for 2 days postoperatively) to prevent AKI after aortic surgery. The exploratory subgroup finding in older patients is explicitly noted by the authors as requiring confirmation and should not guide current practice.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Acute kidney injury (AKI) is a common complication after cardiac surgery and is associated with increased mortality. Amino acids may improve renal perfusion, but their effect in patients undergoing aortic surgery remains unclear. We used the Aortic Surgery Database of the Shanghai Hospital Development Center to emulate a target trial. Patients were classified to one of two exposure strategies: receiving a daily amino acid dose of > 21 g during the first 2 postoperative days, or not receiving amino acid therapy above this threshold. Overlap weighting was used to balance covariates and emulate randomized assignment. The primary outcome was the incidence of AKI. Secondary outcomes included AKI stage, renal replacement therapy, hospital stay, in-hospital mortality, and 30-day mortality. Overall, 1,816 patients were included in the study. The incidence of AKI and 30-day mortality was 37.8% (n = 686) and 1.6% (n = 29), respectively. No significant association was observed between low-dose postoperative amino acid exposure and the incidence of AKI (OR = 0.96, 95% CI: 0.79-1.17, p = 0.70) or 30-day mortality (OR = 1.54, 95% CI: 0.68-3.50, p = 0.30). In subgroup analysis, amino acid exposure was associated with a lower risk of AKI in patients aged ≥ 65 years (OR = 0.71, 95% CI: 0.53-0.95, p = 0.02). The subgroup finding in older patients should be considered exploratory and requires confirmation in future studies.
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