Efficacy and safety of perioperative sodium bicarbonate therapy for cardiac surgery-associated acute kidney injury: a meta-analysis.

Abstract

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. PubMed, CBM, EMBASE, CENTRAL, and Cochrane renal group specialized register were searched for pertinent studies. 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. Study end points, study design, population, operation information, and sodium bicarbonate doses were extracted. 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. 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.