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Effect of perioperative sodium bicarbonate administration on renal function following cardiac surgery for infective endocarditis: a randomized, placebo-controlled trial

 Jin Sun Cho  ;  Sarah Soh  ;  Jae-Kwang Shim  ;  Sanghwa Kang  ;  Haegi Choi  ;  Young-Lan Kwak 
 Critical Care, Vol.21(1) : 3, 2017 
Journal Title
 Critical Care 
Issue Date
Cardiac surgery ; Infective endocarditis ; Renal function ; Sodium bicarbonate
BACKGROUND: 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. METHODS: 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. RESULTS: The peak SCr during the first 48 h postoperatively (bicarbonate vs. CONTROL: 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. CONTROL: 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). CONCLUSIONS: 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. TRIAL REGISTRATION: ClinicalTrials.gov, NCT01920126 . Registered on 31 July 2013.
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
Yonsei Authors
Kwak, Young Lan(곽영란) ORCID logo https://orcid.org/0000-0002-2984-9927
Soh, Sa Rah(소사라) ORCID logo https://orcid.org/0000-0001-5022-4617
Shim, Jae Kwang(심재광) ORCID logo https://orcid.org/0000-0001-9093-9692
Cho, Jin Sun(조진선) ORCID logo https://orcid.org/0000-0002-5408-4188
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