title: Efficacy and safety of perioperative sodium bicarbonate therapy for cardiac surgery-associated acute kidney injury: a meta-analysis.
abstract: OBJECTIVE
  Urinary alkalinization with sodium bicarbonate infusion can theoretically protect against the mechanisms of acute kidney injury (AKI). Controversy exists regarding whether sodium bicarbonate infusion can reduce the incidence of AKI from cardiac surgery. A meta-analysis was conducted to show the efficacy and safety of perioperative sodium bicarbonate use for preventing AKI in patients undergoing cardiac surgery.
  
  
  METHODS
  PubMed, CBM, EMBASE, CENTRAL, and Cochrane renal group specialized register were searched for pertinent studies.
  
  
  METHODS
  Randomized controlled trails and prospective observational cohort studies that compared sodium bicarbonate with sodium chloride or blank control in cardiac surgery with cardiopulmonary bypass were included. Exclusion criteria were duplicate publications, nonadult studies, oral administration of sodium bicarbonate, retrospective analyses, and studies with small sample size (n < 50) or with no data on AKI.
  
  
  METHODS
  Study end points, study design, population, operation information, and sodium bicarbonate doses were extracted.
  
  
  RESULTS
  Data from 1673 patients in 5 randomized trials and 1 prospective observational cohort study were analyzed. The analysis showed that sodium bicarbonate did not reduce the incidence of postoperative AKI and the need for renal replacement therapy. Postoperative ventilation time, hospital length of stay, hospital death, and mortality within 90 days had no statistical difference between 2 groups. Time in intensive care unit was even slightly longer in the experimental group.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Nephrology, Institute of Nephritic and Urinary Disease, Guizhou Provincial People's Hospital, Guiyang, China.
authors.forename: Mao-Lu
authors.initials: ML
authors.lastname: Tian
authors.forename: Ying
authors.initials: Y
authors.lastname: Hu
authors.forename: Jing
authors.initials: J
authors.lastname: Yuan
authors.forename: Yan
authors.initials: Y
authors.lastname: Zha
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D002021:Buffers; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D019990:Perioperative Care / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D016032:Randomized Controlled Trials as Topic; D017582:Renal Replacement Therapy / Q000706:statistics & numerical data; D017693:Sodium Bicarbonate / Q000494:pharmacology*
chemical_list: D002021:Buffers; D017693:Sodium Bicarbonate