Renal effects of amino acid infusion in cardiac surgery |
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| Authors: | Jeppsson A Ekroth R Friberg P Kirnö K Milocco I Nilsson F Svensson S |
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| Institution: | 1. Department of Animal Sciences, Auburn University, Auburn, AL, United States;2. Department of Pediatrics, USDA/Agricultural Research Service, Children’s Nutrition Research Center, Baylor College of Medicine, Houston, Texas, United States;1. Food Biochemistry Laboratory, Department of Applied Biological Chemistry, Graduate School of Agricultural and Life Sciences, The University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo, 113-8657, Japan;2. Nutri-Life Science Laboratory, Department of Applied Biological Chemistry, Graduate School of Agricultural and Life Sciences, The University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo, 113-8657, Japan;3. AMED-CREST, Japan Agency for Medical Research and Development, 1-7-1 Otemachi, Chiyoda-ku, Tokyo, 100-0004, Japan;1. Muscle Health Research Centre, York University, Toronto, Ontario, M3J 1P3, Canada;2. School of Kinesiology and Health Science, York University, Toronto, Ontario, M3J 1P3, Canada;1. Case Western Reserve University School of Medicine, Cleveland, Ohio;2. MetroHealth, Internal Medicine and Pediatrics, Cleveland, Ohio;3. University Hospitals Cleveland Medical Center/UH Rainbow Babies and Children''s Hospital, Pediatric Gastroenterology, Hepatology, and Nutrition, Cleveland, Ohio;4. University Hospitals Cleveland Medical Center/UH Rainbow Babies and Children''s Hospital, Neonatology and Perinatal Medicine, Cleveland, Ohio;5. University Hospitals Cleveland Medical Center, Clinical Research Center, Cleveland, Ohio;6. University Hospitals Cleveland Medical Center/UH Rainbow Babies and Children''s Hospital, Pediatric Surgery, Cleveland, Ohio;1. Department of Pharmacy, The Johns Hopkins Hospital, 600 North Wolfe Street, Carnegie Bldg Room 180, Baltimore, MD 21287, USA;2. Clinical Center Pharmacy Department, National Institutes of Health, 10 Center Drive, Room 1C240, Bethesda, MD 20892, USA;3. Department of Clinical Nutrition, The Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD 21287, USA;4. Department of Nutrition, Holy Cross Hospital, 1500 Forest Glen Rd, Silver Spring, MD 20910, USA;1. UGC Endocrinología y Nutrición, IBIMA, Hospital Regional Universitario de Málaga/ Universidad de Málaga, Malaga, Spain;2. CIBERDEM, CIBER of Diabetes and Associated Metabolic Diseases (CB07/08/0019), Instituto de Salud Carlos III, Spain;3. Endocrinology and Nutrition Service, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain;4. Endocrinology and Nutrition Service, Complejo Asistencial Universitario de León, Spain;5. Endocrinology and Nutrition Service, Complejo Hospitalario de Jaén, Spain;6. Endocrinology and Nutrition, Hospital Son Llàtzer (Palma de Mallorca), Spain;7. Endocrinology and Nutrition Service, Hospital General Mancha Centro, Alcázar de San Juan, Ciudad-Real, Spain;8. Endocrinology and Nutrition Service, Complejo Hospitalario Universitario de Albacete, Spain;9. Endocrinology and Nutrition Service, Hospital Clínico San Carlos, Madrid, Spain;10. Clinical Nutrition Unit, University Hospital Vall d''Hebron, Barcelona, Spain;11. Endocrinology and Nutrition Service, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain;12. Clinical Nutrition Unit, Complejo Hospitalario de Navarra, Spain;13. Endocrinology and Nutrition Service, Hospital de Cabueñes, Gijón, Asturias, Spain;14. Endocrinology and Nutrition Service, Hospital del Mar, Barcelona, Spain;15. Endocrinology and Nutrition Service, Hospital Universitario Son Dureta, Palma de Mallorca, Spain;p. Endocrinology and Nutrition Service, Fundación Jiménez Díaz, Madrid, Spain;q. Endocrinology and Nutrition Service, Hospital Universitario Gregorio Marañón, Madrid, Spain;r. Endocrinology and Nutrition Service, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain;s. Endocrinology and Nutrition Service, Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain;t. Endocrinology and Nutrition Service, Hospital Universitario Virgen del Rocio, Seville, Spain |
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| Abstract: | OBJECTIVE: To evaluate effects of amino acids on renal function and oxygen consumption and the role of individual amino acids on renal blood flow (RBF) changes. DESIGN: Prospective, randomized, controlled study. SETTING: Operating room in cardiothoracic surgery department, university hospital. PARTICIPANTS: Twenty-two male patients submitted to elective first-time coronary artery bypass surgery. INTERVENTIONS: A catheter was placed in the left renal vein for thermodilution RBF measurements and blood sampling. In 11 patients, a balanced mixed amino acid infusion was infused (200 mL/hr) for 30 minutes immediately after the operation. MEASUREMENTS AND MAIN RESULTS: RBF and glomerular filtration rate increased during amino acid infusion compared with the control group. Renal oxygen consumption increased in the amino acid group and correlated with the increase in RBF (r = 0.70, p<0.001). Amino acid infusion induced two- to fourfold increases in plasma concentrations of individual amino acid concentrations and promoted renal extraction of aspartate, glutamate, glycine, and histidine. No correlation was observed between arterial concentration or uptake of individual amino acids and RBF. CONCLUSIONS: The increase in RBF from a mixed amino acid infusion was associated with increased glomerular filtration rate and renal consumption of oxygen. Changes in RBF of a mixed amino acid infusion could not be linked to plasma level or renal uptake of any individual amino acids. |
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