Efficacy and Safety of Perioperative Sodium Bicarbonate Therapy for Cardiac Surgery-associated Acute Kidney Injury

Tian, Maolu; Hu, Ying; Yuan, Jing; Zha, Yan

doi:10.1097/fjc.0000000000000169

Cited by 18 publications

(9 citation statements)

References 29 publications

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“…The inability of sodium bicarbonate to reduce AKI was discussed from the perspective of alkalemia and resultant physiologic changes in previous studies [13–15]. Alkalemia can lead to impaired tissue perfusion [33, 34] and oxygen delivery [35], and to increased cell death and apoptosis associated with superoxide formation [36].…”

Section: Discussionmentioning

confidence: 99%

Effect of perioperative sodium bicarbonate administration on renal function following cardiac surgery for infective endocarditis: a randomized, placebo-controlled trial

et al. 2017

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BackgroundPatients with infective endocarditis (IE) have an elevated risk of renal dysfunction because of extensive systemic inflammation and use of nephrotoxic antibiotics. In this randomized, placebo-controlled trial, we investigated whether perioperative sodium bicarbonate administration could attenuate postoperative renal dysfunction in patients with IE undergoing cardiac surgery.MethodsSeventy patients randomly received sodium chloride (n = 35) or sodium bicarbonate (n = 35). Sodium bicarbonate was administered as a 0.5 mmol/kg loading dose for 1 h commencing with anesthetic induction, followed by a 0.15 mmol/kg/h infusion for 23 h. The primary outcome was peak serum creatinine (SCr) level during the first 48 h postoperatively. The incidence of acute kidney injury, SCr level, estimated glomerular filtration rate, and major morbidity endpoints were assessed postoperatively.ResultsThe peak SCr during the first 48 h postoperatively (bicarbonate vs. control: 1.01 (0.74, 1.37) mg/dl vs. 0.88 (0.76, 1.27) mg/dl, P = 0.474) and the incidence of acute kidney injury (bicarbonate vs. control: 29% vs. 23%, P = 0.584) were similar in both groups. The postoperative increase in SCr above baseline was greater in the bicarbonate group than in the control group on postoperative day 2 (0.21 (0.07, 0.33) mg/dl vs. 0.06 (0.00, 0.23) mg/dl, P = 0.028) and postoperative day 5 (0.23 (0.08, 0.36) mg/dl vs. 0.06 (0.00, 0.23) mg/dl, P = 0.017).ConclusionsPerioperative sodium bicarbonate administration had no favorable impact on postoperative renal function and outcomes in patients with IE undergoing cardiac surgery. Instead, it was associated with possibly harmful renal effects, illustrated by a greater increase in SCr postoperatively, compared to control.Trial registrationClinicalTrials.gov, NCT01920126. Registered on 31 July 2013.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1591-z) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Effect of perioperative sodium bicarbonate administration on renal function following cardiac surgery for infective endocarditis: a randomized, placebo-controlled trial

et al. 2017

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“…Tian et al [78] performed a meta-analysis of trials of sodium bicarbonate in cardiac surgery that included five RCTs and one prospective observational cohort study (a total of 1673 patients). There was no difference in the incidence of CSA-AKI.…”

Section: Sodium Bicarbonatementioning

confidence: 99%

Acute kidney injury in cardiac surgery

Gaffney

Sladen

2015

Current Opinion in Anaesthesiology

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“…38 Based on those findings, some investigators attempted to prevent AKI through urine alkalization by sodium bicarbonate infusion, but the results of those trials were inconsistent. 39,40 The results of the present study could aid in the selection of patients at high risk of AKI, and such therapeutic interventions might be of benefit to them.…”

Section: Discussionmentioning

confidence: 81%

Preoperative Low Serum Bicarbonate Levels Predict Acute Kidney Injury After Cardiac Surgery

et al. 2016

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Acute kidney injury (AKI) after cardiac surgery is a common and serious complication. Although lower than normal serum bicarbonate levels are known to be associated with consecutive renal function deterioration in patients with chronic kidney injury, it is not well-known whether preoperative low serum bicarbonate levels are associated with the development of AKI in patients who undergo cardiac surgery. Therefore, the clinical implication of preoperative serum bicarbonate levels on AKI occurrence after cardiac surgery was investigated. Patients who underwent coronary artery bypass or valve surgery at Yonsei University Health System from January 2013 to December 2014 were enrolled. The patients were divided into 3 groups based on preoperative serum bicarbonate levels, which represented group 1 (below normal levels) <23 mEq/L; group 2 (normal levels) 23 to 24 mEq/L; and group 3 (elevated levels) >24 mEq/L. The primary outcome was the predicated incidence of AKI 48 hours after cardiac surgery. AKI was defined according to Acute Kidney Injury Network criteria. Among 875 patients, 228 (26.1%) developed AKI within 48 hours after cardiac surgery. The incidence of AKI was higher in group 1 (40.9%) than in group 2 (26.5%) and group 3 (19.5%) (P < 0.001). In addition, the duration of postoperative stay in a hospital intensive care unit (ICU) was longer for AKI patients and for those in the low-preoperative-serum-bicarbonate-level groups. A multivariate logistic regression analysis showed that low preoperative serum bicarbonate levels were significantly associated with AKI even after adjustment for age, sex, hypertension, diabetes mellitus, operation type, preoperative hemoglobin, and estimated glomerular filtration rate. In conclusion, low serum bicarbonate levels were associated with higher incidence of AKI and prolonged ICU stay. Further studies are needed to clarify whether strict correction of bicarbonate levels close to normal limits may have a protective role in preventing further AKI development.

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Efficacy and Safety of Perioperative Sodium Bicarbonate Therapy for Cardiac Surgery-associated Acute Kidney Injury

Abstract: Urinary alkalinization using sodium bicarbonate infusion failed to reduce the incidence rate of AKI or other outcomes in patients undergoing cardiac surgery. This intervention might even prolong intensive care unit stay.

Cited by 18 publications

References 29 publications

Effect of perioperative sodium bicarbonate administration on renal function following cardiac surgery for infective endocarditis: a randomized, placebo-controlled trial

Effect of perioperative sodium bicarbonate administration on renal function following cardiac surgery for infective endocarditis: a randomized, placebo-controlled trial

Acute kidney injury in cardiac surgery

Preoperative Low Serum Bicarbonate Levels Predict Acute Kidney Injury After Cardiac Surgery

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