Sodium bicarbonate to prevent cardiac surgery-associated kidney injury: the end of a dream?

Jean-Michel Hougardy,Daniel De Backer

doi:10.1186/cc11837

Abstract

The rationale of urine alkalinization through intravenous sodium bicarbonate to prevent cardiac surgery-associated acute kidney injury relies on several pathophysiological arguments. Urine alkalinization is easily feasible in the ICU setting and is often considered to be associated with few side effects. In a previous issue of Critical Care, a retrospective study evaluates the effect of routine intravenous bicarbonate use to prevent cardiac surgery-associated acute kidney injury with cardiopulmonary bypass. This commentary discusses recent data on the use of bicarbonate to prevent cardiac surgery-associated acute kidney injury.

Highlights

The rationale of urine alkalinization through intravenous sodium bicarbonate to prevent cardiac surgery-associated acute kidney injury relies on several pathophysiological arguments
*Correspondence: ddebacke@ulb.ac.be 2Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, B-1070 Brussels, Belgium Full list of author information is available at the end of the article
cardiopulmonary bypass (CPB) is associated with ischemia-reperfusion injury and with significant release of free hemoglobin and iron

Summary

Introduction

The rationale of urine alkalinization through intravenous sodium bicarbonate to prevent cardiac surgery-associated acute kidney injury relies on several pathophysiological arguments. In a previous issue of Critical Care, Heringlake and colleagues [1] report important results of a cohort analysis of use of bicarbonate to prevent cardiac surgeryassociated acute kidney injury (CSA-AKI). Acute kidney injury (AKI) is common in hospitalized patients and is associated with increased morbidity and mortality. Cardiac surgery with cardiopulmonary bypass (CPB) is the second leading cause of AKI in the ICU, just after sepsis [2].

Results

Conclusion