Cardiac surgery associated acute kidney injury (CSA-AKI) is associated with poor outcomes including increased mortality, length of hospital stay (LOS) and cost. The incidence of acute kidney injury (AKI) is reported to be between 3 and 30% depending on the definition of AKI. We designed a multicenter randomized controlled trial to test our hypothesis that a perioperative infusion of sodium bicarbonate (SB) during cardiac surgery will attenuate the post-operative rise in creatinine indicating renal injury when compared to a perioperative infusion with normal saline. An interim analysis was performed after data was available on the first 120 participants. A similar number of patients in the two treatment groups developed AKI, defined as an increase in serum creatinine the first 48 h after surgery of 0.3 mg/dl or more. Specifically 14 patients (24%) who received sodium chloride (SC) and 17 patients (27%) who received SB were observed to develop AKI post-surgery, resulting in a relative risk of AKI of 1.1 (95% CI: 0.6–2.1, chi-square p-value = 0.68) for patients receiving SB compared to those who received SC. The data safety monitoring board for the trial recommended closing the study early as there was only a 12% probability that the null hypothesis would be rejected. We therefore concluded that a perioperative infusion of SB failed to attenuate the risk of CSA-AKI.
Keywords: acute kidney injury, cardiovascular surgery, bicarbonate therapy
Citation: Turner KR, Fisher EC, Hade EM, Houle TT and Rocco MV (2014) The role of perioperative sodium bicarbonate infusion affecting renal function after cardiothoracic surgery. Front. Pharmacol. 5:127. doi: 10.3389/fphar.2014.00127
Received: 28 March 2014; Paper pending published: 14 April 2014;
Accepted: 12 May 2014; Published online: 02 June 2014.
Edited by:Nicoleta Stoicea, Ohio State University Wexner Medical Center, USA
Reviewed by:Norma Beatriz Ojeda, University of Mississippi Medical Center, USA
Copyright © 2014 Turner, Fisher, Hade, Houle and Rocco. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Katja R. Turner, Department of Anesthesiology, Wexner Medical Center at the Ohio State University, N411 Doan Hall, 410 W.10th Ave, Columbus, OH 43210, USA e-mail: firstname.lastname@example.org