A therapy able to prevent acute kidney failure identified for the first time in the world

There are over 300 million surgical operations in the world every year, 1 million performed with the aid of cardiopulmonary bypass. The body and organs of patients undergoing surgery are subjected to acute stress and several studies state that the kidneys are especially affected by surgical stress, as renal perfusion is reduced and the risk of developing acute renal failure increases (ARF), which can subsequently progress to chronic kidney disease. To date, there has never been a specific preventive intervention for acute renal failure other than the implementation of supportive measures. ARF, present in 10-15% of all hospitalized patients in the world (about half a million per year) and in 50% of patients hospitalized in intensive care, represents a critical condition with high mortality and morbidity. In fact, one study found that the 90-day mortality rate in critically ill patients with ARF can be as high as 30-40%​​, making this event significantly more deadly than myocardial infarction.

The work just published in the prestigious New England Journal of Medicine (NEJM) was coordinated by Professor Giovanni Landoni, director of the Anesthesia and Resuscitation Research Center of the IRCCS San Raffaele Hospital and Full Professor at the Vita-Salute San Raffaele University, and by Professor Alberto Zangrillo, head of the General, Cardio-Thoraco-Vascular Anesthesia and Resuscitation Operational Unit and of the Cardiological and Cardiac Surgery Intensive Care Area, Manager of the Clinical Areas of the IRCCS San Raffaele Hospital, Professor of Anesthesia and Resuscitation at the Faculty of Medicine and Surgery and vice-rector for institutional clinical activities of the Vita-Salute San Raffaele University, and conducted in collaboration with various Italian centers and around the world - in particular with Professor Rinaldo Bellomo, Professor of Intensive Care at the University of Melbourne and PhD in critical care. The research demonstrates for the first time the effectiveness of intravenous administration of amino acids to prevent ARF following cardiopulmonary bypass surgery.

The international study coordinated by the IRCCS San Raffaele Hospital, financed thanks to the victory of a Grant from the Italian Ministry of Health, saw the participation of 3,511 patients from 22 centers, including Italy, Croatia and Singapore and will be presented by Professor Giovanni Landoni and Dr. Martina Baiardo Redaelli on 12-14 June in Belfast, on the occasion of the Critical Care Reviews Meeting 2024, the scientific conference that highlights the best clinical studies in intensive care in the world.

The researchers administered the amino acid therapy intravenously to a first group of 1,759 adult patients who were undergoing cardiac surgery with cardiopulmonary bypass and in the three days following the surgery, while for the remaining 1,752 it was administered a placebo. They then found that ARF occurred in 474 patients in the group who received the drug (26.9%) compared to 555 patients in the group who received the placebo (31.7%), recording a decreased likelihood of occurrence of ARF by 5%.

We have seen that, by administering a solution of amino acids intravenously from the moment immediately before the operation up to three days post-surgery, the kidney is able to maintain good perfusion, optimizing renal oxygenation and glomerular filtration, thus highly decreasing the probability of an ARF arising,

explains Professor Giovanni Landoni.

After decades in which studies on amino acids were mainly based on their nutritional effect or on raising body temperature, the San Raffaele research paves the way for new uses, promising an update of the guidelines and a revolution in the clinical field:

The data we have collected with this study confirm that amino acid therapy is able to prevent acute renal failure. From today we will be able to study and perhaps apply these results not only to bypass surgeries, but also to those suffering from heart failure, to those undergoing kidney transplants, to those with ongoing renal failure, to septic patients and it can also be used to reduce damage from contrast agents,

says Professor Alberto Zangrillo.

We are confident that our contribution can make a difference in the world of medicine. It is the first time in history that we protect the kidney pre- and post-surgery with a drug: this paradigm shift could improve the outcome of millions of patients every year,

concludes Professor Rinaldo Bellomo.