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A perioperative infusion of sodium bicarbonate does not improve renal function in cardiac surgery patients: a prospective observational cohort study
Critical Care, 08/17/2012
Clinical Article
Heringlake M et al. – Routine perioperative administration of sodium bicarbonate failed to improve postoperative renal function in a large population of cardiac surgical patients.
Methods- Starting in 4/2009, all patients undergoing cardiac surgery at the institution were enrolled in a prospective trial analyzing the relationship between preoperative cerebral oxygen saturation and postoperative organ dysfunction.
- The authors used this prospectively sampled data set to perform a cohort analysis of the renoprotective efficiency of a 24h continuous perioperative infusion of sodium–bicarbonate on the incidence of CSA–AKI that was routinely introduced in 7/2009.
- After exclusion of patients with endstage chronic kidney disease, off–pump procedures, and emergency cases, perioperative changes in renal function were assessed in 280 patients treated with a perioperative infusion of 4mmol sodium–bicarbonate/kg body weight in comparison with a control cohort of 304 patients enrolled from April to June in this prospective cohort study.
- Postoperative changes in urine flow, plasma creatinine, estimated creatinine clearance, and the need for renal replacement therapy were determined according to AKI injury network criteria.
- Concomitantly, hemodynamics, treatments, complications, and clinical outcomes were recorded.
- Univariate statistical analyses were performed para– and nonparametrically, as appropriate.
- With the exception of a lower prevalence of a history of myocardial infarction and a lower preoperative use of intravenous heparin in the bicarbonate–group, no significant between group differences in patient demographics, surgical risk, type, and duration of surgery were observed.
- Patients in the bicarbonate group had a lower mean arterial blood pressure after induction of anesthesia, needed more fluids, more vasopressors, and a longer treatment time in the high dependency unit.
- Despite a higher postoperative diuresis, no differences in the incidence of AKI grade 1 to 3 and the need for renal replacement were observed.