Acute renal failure: no clear role for essential amino acids.

Clinical bottom line (level 1a-)

  1. Patients with acute renal failure who were given essential amino acids with hypertonic glucose had no clear difference in death than those given hypertonic glucose alone.
Naylor et al: Renal Failure 1987; 10 (3): 141-152
Expires April 2003

The study

Systematic review of all articles of
  • Patients: acute renal failure
  • Intervention: essential amino acids and hypertonic glucose compared with hypertonic glucose alone
  • Outcome: death


    • Articles found in ? using MEDLINE, 1966 to Feb 1987 (search terms: explode 'parenteral feeding', 'random allocation' or 'clinical trials' and 'human' ) and bibliographic references from review articles and trial reports were also searched

    Selection criteria: as above
    Appraisal criteria: articles were appraised using detailed set criteria by two blinded reviewers and given a quality score
    Articles excluded if: reported no clinical outcomes, no concurrent control group described

    Four randomised controlled trials and one cohort study were included.
    • pooled data was combined and weighted according to quality.
    Significant heterogeneity was noted.

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    death unknown 25
    (61%)    		 23
    (46%)    		 25%
    (-11% to 49%)    		 15.0%
    (-5.37% to 35.3%)    		 7
    (NNT = 3 to infinity;
    NNH = 19 to infinity)
    death if not dialysed unknown 5
    (33%)    		 1
    (7.1%)    		 79%
    (-61% to 97%)    		 26.2%
    (-1.22% to 53.6%)    		 4
    (NNT = 2 to infinity;
    NNH = 82 to infinity)

    Comments

    1. Studies are too small and heterogeneous to show any clear benefit from using essential amino acids.
    2. No odds ratios were provided.
    3. Results were pooled for death from only three studies.

    Citation

    1. Naylor CD, Detsky AS, O'Rourke K, et al: Does treatment with essential amino acids and hypertonic glucose improve survival in acute renal failure: a meta-analysis. Renal Failure 1987; 10 (3): 141-152
    Search Terms: acute renal failure in Cochrane
    Contributor: Chris Ball and Clare Wotton, April 2000
    Reviewer:

    Clinical Question.
    Patient acute renal failure
    Intervention or Exposure essential amino acids
    Comparison non-essential amino acids
    Outcome death