Sodium bicarbonate and renal function after cardiac surgery: a prospectively planned individual patient meta-analysis

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Abstract

Background: The effect of urinary alkalinization in cardiac surgery patients at risk of acute kidney injury (AKI) is controversial and trial findings conflicting. Accordingly, the authors performed a prospectively planned individual patient data meta-analysis of the double-blind randomized trials in this field. Methods: The authors studied 877 patients from three double-blind, randomized controlled trials enrolled to receive either 24h of intravenous infusion of sodium bicarbonate or sodium chloride. The primary outcome measure was a postoperative increase in serum creatinine concentration of greater than 25 or 0.5mg/dl (> 44 ?m/L) within the first five postoperative days. Secondary outcomes included the raw change in serum creatinine, greater than 50 and greater than 100 rises in serum creatinine, developing AKI (Acute Kidney Injury Network criteria), initiation of renal replacement therapy, morbidity, and mortality. Results: Patients were similar in demographics, comorbidities, and cardiac procedures. Sodium bicarbonate increased plasma bicarbonate (P <0.001) and urine pH (P <0.001). There were no differences in the development of the primary outcome (Bicarbonate 45 [39?51 vs. Saline 42 [36?48 , P = 0.29). This result remained unchanged when controlling for study and covariates (odds ratio [OR], 99 confidence interval [CI]: Bicarbonate vs. Control, 1.11 [0.77?1.60], P = 0.45). There was, however, a significant study-adjusted benefit in elective coronary artery bypass surgery patients in terms of renal replacement therapy (Bicarbonate vs. Control, OR: 0.38 [99 CI: 0.25?0.58], P <0.0001) and the development of an Acute Kidney Injury Network grade = 3 (Bicarbonate vs. Control, OR: 0.45 [99 CI: 0.43?0.48], P <0.0001). Conclusions: Urinary alkalinization using sodium bicarbonate infusion is not associated with an overall lower incidence of AKI; however, it reduces severe AKI and need for renal replacement therapy in elective coronary artery bypass patients.
Original languageEnglish
Pages (from-to)294 - 306
Number of pages13
JournalAnesthesiology
Volume122
Issue number2
DOIs
Publication statusPublished - 2015

Cite this

@article{35e65329ff0d4df885f08ab29145fd61,
title = "Sodium bicarbonate and renal function after cardiac surgery: a prospectively planned individual patient meta-analysis",
abstract = "Background: The effect of urinary alkalinization in cardiac surgery patients at risk of acute kidney injury (AKI) is controversial and trial findings conflicting. Accordingly, the authors performed a prospectively planned individual patient data meta-analysis of the double-blind randomized trials in this field. Methods: The authors studied 877 patients from three double-blind, randomized controlled trials enrolled to receive either 24h of intravenous infusion of sodium bicarbonate or sodium chloride. The primary outcome measure was a postoperative increase in serum creatinine concentration of greater than 25 or 0.5mg/dl (> 44 ?m/L) within the first five postoperative days. Secondary outcomes included the raw change in serum creatinine, greater than 50 and greater than 100 rises in serum creatinine, developing AKI (Acute Kidney Injury Network criteria), initiation of renal replacement therapy, morbidity, and mortality. Results: Patients were similar in demographics, comorbidities, and cardiac procedures. Sodium bicarbonate increased plasma bicarbonate (P <0.001) and urine pH (P <0.001). There were no differences in the development of the primary outcome (Bicarbonate 45 [39?51 vs. Saline 42 [36?48 , P = 0.29). This result remained unchanged when controlling for study and covariates (odds ratio [OR], 99 confidence interval [CI]: Bicarbonate vs. Control, 1.11 [0.77?1.60], P = 0.45). There was, however, a significant study-adjusted benefit in elective coronary artery bypass surgery patients in terms of renal replacement therapy (Bicarbonate vs. Control, OR: 0.38 [99 CI: 0.25?0.58], P <0.0001) and the development of an Acute Kidney Injury Network grade = 3 (Bicarbonate vs. Control, OR: 0.45 [99 CI: 0.43?0.48], P <0.0001). Conclusions: Urinary alkalinization using sodium bicarbonate infusion is not associated with an overall lower incidence of AKI; however, it reduces severe AKI and need for renal replacement therapy in elective coronary artery bypass patients.",
author = "Bailey, {Michael John} and McGuinness, {Shay P} and Michael Haase and Anja Haase-Fielitz and Parke, {Rachael L} and Hodgson, {Carol Lynette} and Forbes, {Andrew Benjamin} and Bagshaw, {Sean M} and Rinaldo Bellomo",
year = "2015",
doi = "10.1097/ALN.0000000000000547",
language = "English",
volume = "122",
pages = "294 -- 306",
journal = "Anesthesiology",
issn = "0003-3022",
publisher = "American Society of Anesthesiologists",
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}

Sodium bicarbonate and renal function after cardiac surgery: a prospectively planned individual patient meta-analysis. / Bailey, Michael John; McGuinness, Shay P; Haase, Michael; Haase-Fielitz, Anja; Parke, Rachael L; Hodgson, Carol Lynette; Forbes, Andrew Benjamin; Bagshaw, Sean M; Bellomo, Rinaldo.

In: Anesthesiology, Vol. 122, No. 2, 2015, p. 294 - 306.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Sodium bicarbonate and renal function after cardiac surgery: a prospectively planned individual patient meta-analysis

AU - Bailey, Michael John

AU - McGuinness, Shay P

AU - Haase, Michael

AU - Haase-Fielitz, Anja

AU - Parke, Rachael L

AU - Hodgson, Carol Lynette

AU - Forbes, Andrew Benjamin

AU - Bagshaw, Sean M

AU - Bellomo, Rinaldo

PY - 2015

Y1 - 2015

N2 - Background: The effect of urinary alkalinization in cardiac surgery patients at risk of acute kidney injury (AKI) is controversial and trial findings conflicting. Accordingly, the authors performed a prospectively planned individual patient data meta-analysis of the double-blind randomized trials in this field. Methods: The authors studied 877 patients from three double-blind, randomized controlled trials enrolled to receive either 24h of intravenous infusion of sodium bicarbonate or sodium chloride. The primary outcome measure was a postoperative increase in serum creatinine concentration of greater than 25 or 0.5mg/dl (> 44 ?m/L) within the first five postoperative days. Secondary outcomes included the raw change in serum creatinine, greater than 50 and greater than 100 rises in serum creatinine, developing AKI (Acute Kidney Injury Network criteria), initiation of renal replacement therapy, morbidity, and mortality. Results: Patients were similar in demographics, comorbidities, and cardiac procedures. Sodium bicarbonate increased plasma bicarbonate (P <0.001) and urine pH (P <0.001). There were no differences in the development of the primary outcome (Bicarbonate 45 [39?51 vs. Saline 42 [36?48 , P = 0.29). This result remained unchanged when controlling for study and covariates (odds ratio [OR], 99 confidence interval [CI]: Bicarbonate vs. Control, 1.11 [0.77?1.60], P = 0.45). There was, however, a significant study-adjusted benefit in elective coronary artery bypass surgery patients in terms of renal replacement therapy (Bicarbonate vs. Control, OR: 0.38 [99 CI: 0.25?0.58], P <0.0001) and the development of an Acute Kidney Injury Network grade = 3 (Bicarbonate vs. Control, OR: 0.45 [99 CI: 0.43?0.48], P <0.0001). Conclusions: Urinary alkalinization using sodium bicarbonate infusion is not associated with an overall lower incidence of AKI; however, it reduces severe AKI and need for renal replacement therapy in elective coronary artery bypass patients.

AB - Background: The effect of urinary alkalinization in cardiac surgery patients at risk of acute kidney injury (AKI) is controversial and trial findings conflicting. Accordingly, the authors performed a prospectively planned individual patient data meta-analysis of the double-blind randomized trials in this field. Methods: The authors studied 877 patients from three double-blind, randomized controlled trials enrolled to receive either 24h of intravenous infusion of sodium bicarbonate or sodium chloride. The primary outcome measure was a postoperative increase in serum creatinine concentration of greater than 25 or 0.5mg/dl (> 44 ?m/L) within the first five postoperative days. Secondary outcomes included the raw change in serum creatinine, greater than 50 and greater than 100 rises in serum creatinine, developing AKI (Acute Kidney Injury Network criteria), initiation of renal replacement therapy, morbidity, and mortality. Results: Patients were similar in demographics, comorbidities, and cardiac procedures. Sodium bicarbonate increased plasma bicarbonate (P <0.001) and urine pH (P <0.001). There were no differences in the development of the primary outcome (Bicarbonate 45 [39?51 vs. Saline 42 [36?48 , P = 0.29). This result remained unchanged when controlling for study and covariates (odds ratio [OR], 99 confidence interval [CI]: Bicarbonate vs. Control, 1.11 [0.77?1.60], P = 0.45). There was, however, a significant study-adjusted benefit in elective coronary artery bypass surgery patients in terms of renal replacement therapy (Bicarbonate vs. Control, OR: 0.38 [99 CI: 0.25?0.58], P <0.0001) and the development of an Acute Kidney Injury Network grade = 3 (Bicarbonate vs. Control, OR: 0.45 [99 CI: 0.43?0.48], P <0.0001). Conclusions: Urinary alkalinization using sodium bicarbonate infusion is not associated with an overall lower incidence of AKI; however, it reduces severe AKI and need for renal replacement therapy in elective coronary artery bypass patients.

UR - http://anesthesiology.pubs.asahq.org/article.aspx?articleid=2091563

U2 - 10.1097/ALN.0000000000000547

DO - 10.1097/ALN.0000000000000547

M3 - Article

VL - 122

SP - 294

EP - 306

JO - Anesthesiology

JF - Anesthesiology

SN - 0003-3022

IS - 2

ER -