Sodium bicarbonate to prevent increases in serum creatinine after cardiac surgery: a pilot double-blind, randomized controlled trial.
OBJECTIVE
To test whether perioperative sodium bicarbonate infusion can attenuate postoperative increases in serum creatinine in cardiac surgical patients.


METHODS
Double-blind, randomized controlled trial.


METHODS
Operating rooms and intensive care unit at a tertiary hospital.


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


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


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. (ClinicalTrials.gov, NCT00334191).
Haase
Michael
M
Department of Nephrology and Intensive Care, Charité University Medicine, Potsdam, Germany.
Haase-Fielitz
Anja
A
Bellomo
Rinaldo
R
Devarajan
Prasad
P
Story
David
D
Matalanis
George
G
Reade
Michael C
MC
Bagshaw
Sean M
SM
Seevanayagam
Narelle
N
Seevanayagam
Siven
S
Doolan
Laurie
L
Buxton
Brian
B
Dragun
Duska
D
D000368:Aged; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007674:Kidney Diseases / Q000097:blood* / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D010865:Pilot Projects; D017693:Sodium Bicarbonate / Q000008:administration & dosage*
D017693:Sodium Bicarbonate; D003404:Creatinine