Prophylactic sodium bicarbonate infusion and acute kidney injury after open heart surgery

April 16, 2013, Public Library of Science

Contrary to the positive findings of a previous pilot study, administration of a sodium bicarbonate-based infusion to induce urinary alkalinization during and after surgery does not reduce the incidence of acute kidney injury (AKI) and may even cause harm in patients undergoing open heart surgery.

These are the conclusions of a study by Anja Haase-Fielitz of the Otto-von-Guericke-University in Magdeburg, Germany, Rinaldo Bellomo of the Austin Hospital in Melbourne, Australia, and colleagues, published in this week's PLOS Medicine, that suggest an infusion of sodium bicarbonate during is not a useful treatment for preventing AKI following open heart surgery.

The authors conducted a multicenter, double-blinded, randomized controlled in 350 adult patients undergoing open heart surgery with the use of cardiopulmonary bypass. Patients received either 24 hours of intravenous infusion of sodium bicarbonate or (saline control) at the beginning of surgery.

The results showed that a significantly larger proportion of patients receiving sodium bicarbonate developed AKI after surgery, as compared to those receiving saline control. Based on these findings the study was terminated before planned recruitment was completed. A key limitation of the study is that a greater proportion of patients receiving sodium bicarbonate had prior to surgery compared to those receiving saline control. After controlling for this difference at baseline, there were no longer significant differences in AKI outcomes between the groups. However, it was observed that a significantly greater proportion of patients receiving sodium bicarbonate died in the hospital after surgery compared to patients receiving saline control.

The authors say: "Urinary alkalinization using sodium bicarbonate infusion was not found to reduce the incidence of acute kidney injury or attenuate tubular damage following open heart surgery; however, it was associated with a possible increase in mortality."

They add: "On this basis of our findings we do not recommend the prophylactic use of perioperative infusions of to reduce the incidence or severity of acute kidney injury in this patient group."

Explore further: Obese patients face increased risk of kidney damage after heart surgery

More information: Haase M, Haase-Fielitz A, Plass M, Kuppe H, Hetzer R, et al. (2013) Prophylactic Perioperative SodiumBicarbonate to Prevent Acute Kidney Injury Following Open Heart Surgery: A Multicenter Double-Blinded Randomized Controlled Trial. PLoS Med 10(4): e1001426. doi:10.1371/journal.pmed.1001426

Related Stories

Obese patients face increased risk of kidney damage after heart surgery

May 24, 2012
Oxidative stress may put obese patients at increased risk of developing kidney damage after heart surgery, according to a study appearing in an upcoming issue of the Journal of the American Society of Nephrology (JASN). Effective ...

Markers warn of progressive kidney problems after heart surgery

March 1, 2012
Blood and urine markers can indicate which patients with an abrupt kidney injury following heart surgery will experience progressive kidney problems, according to a study appearing in an upcoming issue of the Journal of the ...

Open heart surgery for kidney disease patients

May 17, 2012
One type of open heart surgery is likely safer than the other for chronic kidney disease (CKD) patients, according to a study appearing in an upcoming issue of the Journal of the American Society of Nephrology (JASN).

Study finds obesity linked to kidney injury after heart surgery

July 3, 2012
(Medical Xpress) -- Obesity increases the risk of acute kidney injury (AKI) following cardiac surgery, according to a Vanderbilt study published in the Journal of the American Society of Nephrology.

Recommended for you

Starting periods before age of 12 linked to heightened risk of heart disease and stroke

January 15, 2018
Starting periods early—before the age of 12—is linked to a heightened risk of heart disease and stroke in later life, suggests an analysis of data from the UK Biobank study, published online in the journal Heart.

'Decorated' stem cells could offer targeted heart repair

January 10, 2018
Although cardiac stem cell therapy is a promising treatment for heart attack patients, directing the cells to the site of an injury - and getting them to stay there - remains challenging. In a new pilot study using an animal ...

Exercise is good for the heart, high blood pressure is bad—researchers find out why

January 10, 2018
When the heart is put under stress during exercise, it is considered healthy. Yet stress due to high blood pressure is bad for the heart. Why? And is this always the case? Researchers of the German Centre for Cardiovascular ...

Two simple tests could help to pinpoint cause of stroke

January 10, 2018
Detecting the cause of the deadliest form of stroke could be improved by a simple blood test added alongside a routine brain scan, research suggests.

Heart-muscle patches made with human cells improve heart attack recovery

January 10, 2018
Large, human cardiac-muscle patches created in the lab have been tested, for the first time, on large animals in a heart attack model. This clinically relevant approach showed that the patches significantly improved recovery ...

Place of residence linked to heart failure risk

January 9, 2018
Location. Location. Location.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.