title: Effect of perioperative sodium bicarbonate administration on renal function following cardiac surgery for infective endocarditis: a randomized, placebo-controlled trial.
abstract: Patients with infective endocarditis (IE) have an elevated risk of renal dysfunction because of extensive systemic inflammation and use of nephrotoxic antibiotics. In this randomized, placebo-controlled trial, we investigated whether perioperative sodium bicarbonate administration could attenuate postoperative renal dysfunction in patients with IE undergoing cardiac surgery.
  
  
  
  Seventy patients randomly received sodium chloride (n = 35) or sodium bicarbonate (n = 35). Sodium bicarbonate was administered as a 0.5 mmol/kg loading dose for 1 h commencing with anesthetic induction, followed by a 0.15 mmol/kg/h infusion for 23 h. The primary outcome was peak serum creatinine (SCr) level during the first 48 h postoperatively. The incidence of acute kidney injury, SCr level, estimated glomerular filtration rate, and major morbidity endpoints were assessed postoperatively.
  
  
  
  The peak SCr during the first 48 h postoperatively (bicarbonate vs.
  
  
  
  1.01 (0.74, 1.37) mg/dl vs. 0.88 (0.76, 1.27) mg/dl, P = 0.474) and the incidence of acute kidney injury (bicarbonate vs.
  
  
  
  29% vs. 23%, P = 0.584) were similar in both groups. The postoperative increase in SCr above baseline was greater in the bicarbonate group than in the control group on postoperative day 2 (0.21 (0.07, 0.33) mg/dl vs. 0.06 (0.00, 0.23) mg/dl, P = 0.028) and postoperative day 5 (0.23 (0.08, 0.36) mg/dl vs. 0.06 (0.00, 0.23) mg/dl, P = 0.017).
  
  
  
  Perioperative sodium bicarbonate administration had no favorable impact on postoperative renal function and outcomes in patients with IE undergoing cardiac surgery. Instead, it was associated with possibly harmful renal effects, illustrated by a greater increase in SCr postoperatively, compared to control.
  
  
  
  ClinicalTrials.gov, NCT01920126 . Registered on 31 July 2013.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Yonsei Cardiovascular Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea.
authors.forename: Jin Sun
authors.initials: JS
authors.lastname: Cho
authors.affiliation: Department of Anesthesiology and Pain Medicine, Yonsei Cardiovascular Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea.
authors.forename: Sarah
authors.initials: S
authors.lastname: Soh
authors.affiliation: Department of Anesthesiology and Pain Medicine, Yonsei Cardiovascular Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea.|Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Jae-Kwang
authors.initials: JK
authors.lastname: Shim
authors.affiliation: Department of Anesthesiology and Pain Medicine, National Health Insurance Corporation Ilsan Hospital, Gyeonggi-do, Republic of Korea.
authors.forename: Sanghwa
authors.initials: S
authors.lastname: Kang
authors.affiliation: Department of Anesthesiology and Pain Medicine, Yonsei Cardiovascular Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea.
authors.forename: Haegi
authors.initials: H
authors.lastname: Choi
authors.affiliation: Department of Anesthesiology and Pain Medicine, Yonsei Cardiovascular Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea. ylkwak@yuhs.ac.|Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea. ylkwak@yuhs.ac.
authors.forename: Young-Lan
authors.initials: YL
authors.lastname: Kwak
mesh_terms: D058186:Acute Kidney Injury / Q000188:drug therapy / Q000517:prevention & control*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000379:methods* / Q000706:statistics & numerical data; D004696:Endocarditis / Q000188:drug therapy* / Q000601:surgery; D005260:Female; D006801:Humans; D007668:Kidney / Q000187:drug effects; D007677:Kidney Function Tests / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010919:Placebos / Q000008:administration & dosage; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D056910:Republic of Korea; D017693:Sodium Bicarbonate / Q000008:administration & dosage* / Q000627:therapeutic use; D012965:Sodium Chloride / Q000008:administration & dosage
chemical_list: D010919:Placebos; D012965:Sodium Chloride; D017693:Sodium Bicarbonate
keywords: Cardiac surgery; Infective endocarditis; Renal function; Sodium bicarbonate