{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,9]],"date-time":"2026-08-09T05:41:34Z","timestamp":1786254094220,"version":"build-2736575974"},"reference-count":18,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T00:00:00Z","timestamp":1776643200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T00:00:00Z","timestamp":1776643200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Artificial Organs"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Acute kidney injury (AKI) remains one of the most frequent and prognostically relevant complications following cardiac surgery, even in the era of modern cardiopulmonary bypass (CPB) management and goal\u2010directed perfusion. Cardiac surgery\u2013associated AKI (CSA\u2010AKI) is associated with increased postoperative morbidity, prolonged hospitalization, neurocognitive complications, and reduced early as well as long\u2010term survival. Although optimization of macrocirculatory parameters and oxygen delivery has demonstrated benefits, renal injury often occurs despite apparently adequate perfusion and oxygenation. Recent evidence suggests that CPB\u2010related metabolic stress and protein catabolism contribute to renal vulnerability. Indeed, intravenous amino acid administration has emerged as a novel metabolic strategy for renal protection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>This narrative review was informed by a structured literature search of PubMed\/MEDLINE, Embase, and the Cochrane Library, covering publications from database inception through March 2025. Search terms included combinations of \u201cacute kidney injury,\u201d \u201ccardiac surgery,\u201d \u201ccardiopulmonary bypass,\u201d \u201camino acids,\u201d \u201cintravenous amino acid infusion,\u201d \u201crenal protection,\u201d and \u201cgoal\u2010directed perfusion\u201d. Randomized controlled trials, meta\u2010analyses, systematic reviews, secondary analyses, and relevant narrative reviews published in English were considered. Particular emphasis was placed on high\u2010quality evidence, including the PROTECTION randomized trial, contemporary meta\u2010analyses, and consensus or expert reviews addressing cardiac surgery\u2013associated acute kidney injury and perioperative metabolic interventions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The literature search identified 124 records; 18 articles were included in the final narrative synthesis after title, abstract, and full\u2010text evaluation. The selected literature comprised a multicenter randomized controlled trial, secondary analyses of randomized data, meta\u2010analyses\/systematic reviews, narrative or expert reviews, and observational or mechanistic studies addressing CSA\u2010AKI. The evidence indicates that CSA\u2010AKI results from an interaction between altered renal perfusion, inflammation, ischemia\u2013reperfusion injury, and CPB\u2010induced metabolic derangement. Intravenous amino acid infusion was consistently associated with reduced postoperative AKI incidence, particularly in patients with preexisting chronic kidney disease, without significant safety concerns. These findings support amino acid administration as a metabolic adjunct to goal\u2010directed perfusion rather than a standalone intervention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Intravenous amino acid infusion is a recent strategy to reduce AKI in cardiac surgery. By targeting the CPB\u2010induced metabolic stress, amino acid administration complements goal\u2010directed perfusion and expands current AKI prevention paradigms beyond hemodynamic optimization alone. Future research should focus on CPB\u2010specific timing, dosing strategies, and integration of metabolic support into multimodal AKI prevention bundles.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/aor.70133","type":"journal-article","created":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T03:15:02Z","timestamp":1776741302000},"page":"1118-1124","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Metabolic Conditioning for Renal Protection During Cardiopulmonary Bypass: A Narrative Review"],"prefix":"10.1111","volume":"50","author":[{"given":"Youssef","family":"El Dsouki","sequence":"first","affiliation":[{"name":"Maastricht University Medical Centre (MUMC)  Maastricht the Netherlands"},{"name":"Cardiovascular Research Centre Maastricht (CARIM)  Maastricht the 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