Sodium bicarbonate therapy for critically ill patients with metabolic acidosis: A scoping and a systematic review

Abstract Background: The role of sodium bicarbonate therapy (SBT) remains controversial. This study aimed to investigate whether hemodynamic status before SBT contributed to the heterogeneous outcomes associated with SBT in acute critically ill patients.Methods: We obtained data from patients with metabolic acidosis from the Medical Information Mart for Intensive Care (MIMIC)-III database. Propensity score matching (PSM) was applied to match the SBT group with the control group. Logistic regression and Cox regression were used to analyze a composite of newly “developed or exacerbated organ dysfunction” (d/eOD) within 7 days of ICU admission and 28-day mortality associated with SBT for metabolic acidosis.Results: A total of 1765 patients with metabolic acidosis were enrolled, and 332 pairs obtained by PSM were applied to the final analyses in the study. An increased incidence of newly d/eOD was observed in the SB group compared with the control group (54.8% vs 44.6%, p<0.01). Multivariable logistic regression indicated that the adjusted OR of SBT for this composite outcome was no longer significant [OR (95% CI): 1.39 (0.9, 1.85); p=0.164]. This effect of SBT did not change with the quintiles stratified by pH. Interestingly, SBT was associated with an increased risk of the composite of newly d/eOD in the subgroup of patients with worsening hemodynamics before SBT [adjusted OR (95% CI): 3.6 (1.84, 7.22), p< 0.001]. Moreover, the risk potential for this composite of outcomes was significantly increased in patients characterized by both worsening [adjusted OR (95% CI): 2.91 (1.54, 5.47), p< 0.001] and unchanged hemodynamics [adjusted OR (95% CI): 1.94 (1.01, 3.72), p=0.046) compared to patients with improved hemodynamics before SBT. Our study failed to demonstrate an association between SBT and 28-day mortality in acute critically ill patients with metabolic acidosis.Conclusions: Our findings suggested that SBT for metabolic acidosis was associated with an increased risk potential for subsequent d/eOD, while the hemodynamic status remained unstable during the acute phase of critical illness.

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Bicarbonate Therapy for Critically Ill Patients with Metabolic Acidosis: A Systematic Review

Cureus ◽

10.7759/cureus.4297 ◽

2019 ◽

Cited By ~ 1

Author(s):

Sanniya Khan Ghauri ◽

Arslaan Javaeed ◽

Khawaja Junaid Mustafa ◽

Anna Podlasek ◽

Abdus Salam Khan

Keyword(s):

Systematic Review ◽

Metabolic Acidosis ◽

Critically Ill ◽

Critically Ill Patients ◽

Bicarbonate Therapy

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Risk Potential for Organ Dysfunction Associated With Sodium Bicarbonate Therapy in Critically Ill Patients With Hemodynamic Worsening

Frontiers in Medicine ◽

10.3389/fmed.2021.665907 ◽

2021 ◽

Vol 8 ◽

Author(s):

Tiehua Wang ◽

Lingxian Yi ◽

Hua Zhang ◽

Tianhao Wang ◽

Jingjing Xi ◽

...

Keyword(s):

Logistic Regression ◽

Metabolic Acidosis ◽

Sodium Bicarbonate ◽

Critically Ill ◽

Organ Dysfunction ◽

Critically Ill Patients ◽

Control Group ◽

Hemodynamic Status ◽

Bicarbonate Therapy ◽

Risk Potential

Background: The role of sodium bicarbonate therapy (SBT) remains controversial. This study aimed to investigate whether hemodynamic status before SBT contributed to the heterogeneous outcomes associated with SBT in acute critically ill patients.Methods: We obtained data from patients with metabolic acidosis from the Medical Information Mart for Intensive Care (MIMIC)-III database. Propensity score matching (PSM) was applied to match the SBT group with the control group. Logistic regression and Cox regression were used to analyze a composite of newly “developed or exacerbated organ dysfunction” (d/eOD) within 7 days of ICU admission and 28-day mortality associated with SBT for metabolic acidosis.Results: A total of 1,765 patients with metabolic acidosis were enrolled, and 332 pairs obtained by PSM were applied to the final analyses in the study. An increased incidence of newly d/eOD was observed in the SB group compared with the control group (54.8 vs. 44.6%, p < 0.01). Multivariable logistic regression indicated that the adjusted OR of SBT for this composite outcome was no longer significant [OR (95% CI): 1.39 (0.9, 1.85); p = 0.164]. This effect of SBT did not change with the quintiles stratified by pH. Interestingly, SBT was associated with an increased risk of the composite of newly d/eOD in the subgroup of patients with worsening hemodynamics before SBT [adjusted OR (95% CI): 3.6 (1.84, 7.22), p < 0.001]. Moreover, the risk potential for this composite of outcomes was significantly increased in patients characterized by both worsening [adjusted OR (95% CI): 2.91 (1.54, 5.47), p < 0.001] and unchanged hemodynamics [adjusted OR (95% CI): 1.94 (1.01, 3.72), p = 0.046] compared to patients with improved hemodynamics before SBT. Our study failed to demonstrate an association between SBT and 28-day mortality in acute critically ill patients with metabolic acidosis.Conclusions: Our findings did not demonstrate an association between SBT and outcomes in critically ill patients with metabolic acidosis. However, patients with either worsening or unchanged hemodynamic status in initial resuscitation had a significantly higher risk potential of newly d/eOD subsequent to SBT.

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Bicarbonate Therapy in Renally Compromised Critically Ill Patients with Metabolic Acidosis: Study of Clinical Outcomes and Mortality Rate

International Journal of General Medicine ◽

10.2147/ijgm.s296095 ◽

2021 ◽

Vol Volume 14 ◽

pp. 2817-2826

Author(s):

Zakia Rafique ◽

Muhammad Haseeb Tariq ◽

Arif-ullah Khan ◽

Muhammad Junaid Farrukh ◽

Nida Khan ◽

...

Keyword(s):

Metabolic Acidosis ◽

Mortality Rate ◽

Clinical Outcomes ◽

Critically Ill ◽

Critically Ill Patients ◽

Bicarbonate Therapy

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The effect of sodium bicarbonate administration on renal function: A systematic review and meta-analysis of clinical trials

10.21203/rs.3.rs-155602/v1 ◽

2021 ◽

Author(s):

Mohammad Tavassoly ◽

Firouzeh Moeinzadeh ◽

Elham-Sadat Hejazi ◽

Cain C. T. Clark ◽

Mohammad Hossein Rouhani

Keyword(s):

Systematic Review ◽

Renal Function ◽

Metabolic Acidosis ◽

Serum Creatinine ◽

Sodium Bicarbonate ◽

Creatinine Clearance ◽

Weighted Mean Difference ◽

Meta Analysis ◽

Study Heterogeneity ◽

Bicarbonate Therapy

Abstract Background Metabolic acidosis is a prevalent condition in patients with chronic kidney disease (CKD). Although sodium bicarbonate is extensively used for management of metabolic acidosis, its efficacy has not been summarized in previous review studies. Objective To conduct a systematic review and meta-analysis to estimate the overall effects of sodium bicarbonate on indices of renal function in patients with CKD. Methods A systematic literature search was carried out through the Medline, Web of Science and Scopus databases, up to July 2020. Studies that reported the effects of oral sodium bicarbonate administration on renal function were included. Blood urea nitrogen (BUN), serum creatinine, glomerular filtration rate (GFR), and creatinine clearance were defined as renal function indices. A random-effects model was used to calculate the overall effect and reported as weighted mean difference (WMD). Results Thirteen studies were included in this systematic review and meta-analysis. A beneficial effect of sodium bicarbonate was observed on BUN (WMD: − 8.63 mg/dL; 95% CI: -11.08, -6.19), serum creatinine (WMD: -0.19 mg/dL; 95% CI: -0.36, -0.02), GFR (WMD: 0.75 ml/min/1.73 m2; 95% CI: 0.14, 1.35), and creatinine clearance (WMD: 4.82 mL/min; 95% CI: 2.68, 6.96). There was no between study heterogeneity for all renal function indices. Also, no publication bias was observed in this study. Conclusion This systematic review and meta-analysis showed that sodium bicarbonate supplementation could increase GFR and creatinine clearance and decrease BUN and creatinine. Therefore, sodium bicarbonate therapy may efficacious in ameliorating the progression of CKD.

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