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This article is part of the supplement: 33rd International Symposium on Intensive Care and Emergency Medicine

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Perioperative sodium bicarbonate to prevent acute kidney injury after cardiac surgery: a multicenter double-blind randomized controlled trial

A Haase-Fielitz1*, M Haase1, M Plass2, P Murray3, M Bailey4, R Bellomo5 and S Bagshaw6

  • * Corresponding author: A Haase-Fielitz

Author Affiliations

1 Otto von-Guericke University, Magdeburg, Germany

2 German Heart Center, Berlin, Germany

3 University College, Dublin, Ireland

4 ANZIC, Melbourne, Australia

5 Austin Hospital, Melbourne, Australia

6 University of Alberta, Canada

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Critical Care 2013, 17(Suppl 2):P413  doi:10.1186/cc12351

The electronic version of this article is the complete one and can be found online at:

Published:19 March 2013

© 2013 Haase-Fielitz et al.; licensee BioMed Central Ltd.

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Evidence suggests a nephroprotective effect of urinary alkalinization in patients at risk of acute kidney injury (AKI).


In a multicenter, double-blind, RCT we enrolled 350 adult cardiac surgery patients. At induction of anesthesia, patients received either 24 hours of intravenous infusion of sodium bicarbonate (5.1 mmol/kg) or sodium chloride (5.1 mmol/kg). The primary endpoint was the proportion of patients developing AKI.


Sodium bicarbonate increased urinary pH (from 6.0 to 7.5, P 0.001). More patients in the bicarbonate group (83/174 (47.7%)) developed AKI compared with control (64/176 (36.4%), OR = 1.60 (95% CI, 1.04 to 2.45); unadjusted P = 0.032). A greater postoperative increase in urinary NGAL in patients receiving bicarbonate infusion was observed compared with control (P = 0.011). The incidence of postoperative RRT was similar but hospital mortality was increased in patients treated with bicarbonate compared with chloride (11/174 (6.3%) vs. 3/176 (1.7%), OR 3.89 (1.07 to 14.2), P = 0.031). See Figure 1.


On this basis of our findings we do not recommend the use of perioperative infusions of sodium bicarbonate to reduce the incidence or severity of AKI in this patient group.