Abstract
Objectives : Acute cardiac dysfunction often leads to acute kidney injury (AKI). The harmful effect of myoglobin seems to be dependent on the acidic urine pH. This study aimed to discover whether urinary alkalinization with an oral combination of sodium citrate, citric acid and potassium hydrogen carbonate (Blemaren®) reduces the prevalence of AKI in patients with severe myocardial infarction. Methods : In this retrospective cohort study, the data from >6.600 consecutive patients between 09/2005-06/2015 were analyzed. Finally, 359 patients with severe myocardial infarction (defined as creatine kinase- levels CKmax> 80µkat/l) could be included. To prevent AKI, 307 patients received Blemaren® treatment. The following statistical methods were used to compare the cohorts: Mann- Whitney- U- test with confirmation by t-test; chi- square- test based on Pearson; statistical correlation analysis based on Pearson; linear and binary logistic regression and Log- Rank- test for comparison of cumulative survival. Results : No significant association between the development of urea, creatinine and GFR with oral urinary alkalization using Blemaren® (p=0.898; p=0.962; p=0.645) was found. Furthermore, in subgroup analyses, Blemaren®- treatment contributed no benefit for high-risk groups (arterial hypertension, cardiogenic shock and initial renal impairment) in terms of development of AKI (p>0.05). Finally, Blemaren® treatment did not improve in-hospital survival, mid-term mortality of about 1 and 2 years or cumulative survival (all p>0.05). Conclusion : Oral urine alkalization with Blemaren® in severe myocardial infarction to prevent AKI and to improve patients’ outcome is no longer appropriate.
Published Version
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