Sodium bicarbonate to prevent increases in serum creatinine after cardiac surgery: a pilot double-blind, randomized controlled trial

Haase, Michael, Haase-Fielitz, Anja, Bellomo, Rinaldo, Devarajan, Prasad, Story, David, Matalanis, George, Reade, Michael C., Bagshaw, Sean M., Seevanayagam, Narelle, Seevanayagam, Siven, Doolan, Laurie, Buxton, Brian and Dragun, Duska (2009) Sodium bicarbonate to prevent increases in serum creatinine after cardiac surgery: a pilot double-blind, randomized controlled trial. Critical Care Medicine, 37 1: 39-47. doi:10.1097/CCM.0b013e318193216f


Author Haase, Michael
Haase-Fielitz, Anja
Bellomo, Rinaldo
Devarajan, Prasad
Story, David
Matalanis, George
Reade, Michael C.
Bagshaw, Sean M.
Seevanayagam, Narelle
Seevanayagam, Siven
Doolan, Laurie
Buxton, Brian
Dragun, Duska
Title Sodium bicarbonate to prevent increases in serum creatinine after cardiac surgery: a pilot double-blind, randomized controlled trial
Journal name Critical Care Medicine   Check publisher's open access policy
ISSN 0090-3493
1530-0293
Publication date 2009-01-01
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1097/CCM.0b013e318193216f
Open Access Status Not yet assessed
Volume 37
Issue 1
Start page 39
End page 47
Total pages 9
Place of publication Philadelphia, PA, United States
Publisher Lippincott Williams & Wilkins
Language eng
Formatted abstract
Objective: To test whether perioperative sodium bicarbonate infusion can attenuate postoperative increases in serum creatinine in cardiac surgical patients.

Design: Double-blind, randomized controlled trial.

Setting: Operating rooms and intensive care unit at a tertiary hospital.

Patients: Cohort of 100 cardiac surgical patients at increased risk of postoperative acute renal dysfunction.

Intervention: Patients were randomized to either 24 hrs of intravenous infusion of sodium bicarbonate (4 mmol/kg) or sodium chloride (4 mmol/kg).

Measurements and Main Results: The primary outcome measure was the proportion of patients developing acute renal dysfunction defined as a postoperative increase in plasma creatinine concentration >25% of baseline within the first five postoperative days. Secondary outcomes included changes in plasma creatinine, plasma urea, urinary neutrophil gelatinase-associated lipocalin, and urinary neutrophil gelatinase-associated lipocalin/urinary creatinine ratio. Patients were well balanced for baseline characteristics. Sodium bicarbonate infusion increased plasma bicarbonate concentration (p < 0.001), base excess (p < 0.001), plasma pH (p < 0.001), and urine pH (p < 0.001). Fewer patients in the sodium bicarbonate group (16 of 50) developed a postoperative increase in serum creatinine compared with control (26 of 50) (odds ratio 0.43 [95% confidence interval 0.19-0.98]), (p = 0.043). The increase in plasma creatinine, plasma urea, urinary neutrophil gelatinase-associated lipocalin, and urinary neutrophil gelatinase-associated lipocalin/urinary creatinine ratio was less in patients receiving sodium bicarbonate, (p = 0.014; p = 0.047; p = 0.009; p = 0.004). There were no significant side effects.

Conclusions: Sodium bicarbonate loading and continuous infusion was associated with a lower incidence of acute renal dysfunction in cardiac surgical patients undergoing cardiopulmonary bypass. The findings of this pilot study justify further investigation.
Keyword Acute renal dysfunction
Cardiac surgery
Cardiopulmonary bypass
Creatinine
Neutrophil gelatinase associated lipocalin
Prevention
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collection: School of Medicine Publications
 
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