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Lack of Effectiveness of Sodium Bicarbonate in Preventing Kidney Injury in Patients Undergoing Cardiac Surgery: A Randomized Controlled Trial
Author(s) -
Kristeller Judith L.,
Zavorsky Gerald S.,
Prior John E.,
Keating Doris A.,
Brady Mary Ann,
Romaldini Theresa A.,
Hickman Tiera L.,
Stahl Russell F.
Publication year - 2013
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1002/phar.1262
Subject(s) - medicine , acute kidney injury , perioperative , sodium bicarbonate , cardiopulmonary bypass , cardiac surgery , kidney disease , randomized controlled trial , anesthesia , adverse effect , surgery , chemistry
Study Objective Because alkalinization of the renal tubules can theoretically protect against the mechanisms of acute kidney injury, we sought to determine whether a sodium bicarbonate infusion can prevent acute kidney injury after cardiac surgery. Design Prospective, randomized, double‐blind, controlled trial. Setting Cardiac surgery service in a community hospital. Patients Ninety‐two patients with stage 3 or higher chronic kidney disease who underwent cardiac surgery using cardiopulmonary bypass. Intervention Forty‐eight patients received a perioperative intravenous infusion of 0.9% sodium chloride 154 mEq/L, and 44 patients received an infusion of sodium bicarbonate infusion 150 mE q/L in 5% dextrose solution; the infusions were started 1 hour preoperatively and continued for 6 hours after cardiopulmonary bypass. Measurements and Main Results The primary outcome was the development of any stage of acute kidney injury within 5 days after surgery as defined by the Acute Kidney Injury Network criteria. No statistically significant difference in the primary outcome was noted between the two groups: 32% in the bicarbonate group versus 42% in the sodium chloride group (p=0.12). Likewise, no significant differences in the 30‐day hospital mortality rate or other adverse outcomes were noted between the two groups. Conclusion A perioperative infusion of sodium bicarbonate did not reduce the rate of acute kidney injury or adverse outcomes in patients with chronic kidney disease who underwent cardiac surgery.