Sodium bicarbonate after heart surgery may harm kidneys in patients with IE
Administration of sodium bicarbonate appears to have no beneficial effects on patients with infective endocarditis (IE) undergoing heart surgery; instead, it may have potentially detrimental effects on renal function as demonstrated by increased postoperative peak serum creatinine (SCr) levels, according to a study.
The randomized, placebo-controlled clinical trial involved 70 patients aged between 20 and 80 years who were assigned to receive either sodium bicarbonate (n=35) or sodium chloride (n=35) as control. Sodium bicarbonate was given as a 0.5 mmol/kg loading dose for 1 hour with induction of anaethesia followed by a 0.15 mmol/kg/h infusion for 23 hours, whereas sodium chloride was similarly administered in equivalent volumes.
The primary outcome was the difference in SCr levels during the first 48 hours after surgery, with a difference in SCr >0.3 mg/dL considered clinically significant based on the Acute Kidney Injury Network criteria. The incidence of acute kidney injury, SCr level, estimated glomerular filtration rate and major morbidity endpoints were assessed postoperatively.
Secondary outcomes included the incidence of postoperative acute kidney injury (AKI), electrolyte abnormalities, major morbidity endpoints (permanent stroke, haemostatic re-exploration, AKI, prolonged ventilator care and deep sternal wound infection), ICU and hospital length of stay, and in-hospital mortality. Changes in eGFR were also assessed.There were no differences observed between groups with regard to peak SCr during the first 48 hours postoperatively and the incidence of AKI. Compared with the control group, there was a greater postoperative increase in SCr above baseline in the bicarbonate group on postoperative day 2 (0.21 mg/dL vs 0.06 mg/dL; p=0.028) and postoperative day 5 (0.23 mg/dL vs 0.06 mg/dL, p=0.017). Postoperative renal and nonrenal function outcomes were similar between groups.