{"id":10609,"date":"2025-12-20T14:19:38","date_gmt":"2025-12-20T10:19:38","guid":{"rendered":"https:\/\/medscriptum.org\/?p=10609"},"modified":"2025-12-20T14:19:53","modified_gmt":"2025-12-20T10:19:53","slug":"sodium-bicarbonate-in-severe-acidemia-and-kidney-injury","status":"publish","type":"post","link":"https:\/\/medscriptum.org\/en\/sodium-bicarbonate-in-severe-acidemia-and-kidney-injury\/","title":{"rendered":"Sodium Bicarbonate in Severe Acidemia and Kidney Injury"},"content":{"rendered":"<p style=\"text-align: justify\" data-path-to-node=\"3\">In critical care medicine, severe metabolic acidemia remains one of the most difficult challenges, as it often accelerates the progression of multi-organ failure. A sharp increase in blood acidity decreases myocardial contractility, increases resistance to vasopressors (vessel-constricting agents), and exacerbates renal dysfunction. This, in turn, creates a need for Kidney Replacement Therapy (KRT). In this clinical context, the role of sodium bicarbonate as a buffer therapy has been a subject of intense debate for decades\u2014was it merely a temporary correction or an intervention providing real clinical benefit?<\/p>\n<p style=\"text-align: justify\" data-path-to-node=\"4\">Against the backdrop of this uncertainty, a large-scale, multicenter randomized study, BICAR-ICU-2, was conducted involving 640 patients with severe metabolic acidemia (<span class=\"math-inline\" data-math=\"pH \\approx 7.15\" data-index-in-node=\"169\"><span class=\"katex\"><span class=\"katex-html\" aria-hidden=\"true\"><span class=\"base\"><span class=\"mord mathnormal\">p<\/span><span class=\"mord mathnormal\">H<\/span><span class=\"mrel\">\u2248<\/span><\/span><span class=\"base\"><span class=\"mord\">7.15<\/span><\/span><\/span><\/span><\/span>) and Acute Kidney Injury (AKI, <a href=\"https:\/\/kdigo.org\" target=\"_blank\" rel=\"noopener\">KDIGO<\/a> stages 2-3). Researchers aimed to determine whether intravenous 4.2% sodium bicarbonate could improve the 90-day survival rate and reduce the need for dialysis compared to standard treatment.<\/p>\n<p style=\"text-align: justify\" data-path-to-node=\"5\">It should be noted that severe acidemia often becomes the reason for the premature initiation of dialysis, as intensivists consider it the second most common indicator for KRT after fluid overload. Until now, international guidelines regarding the use of bicarbonate provided rather cautious and weak directions, due to a deficit of solid scientific evidence.<\/p>\n<p style=\"text-align: justify\" data-path-to-node=\"6\">The study was conducted across 43 intensive care units in France and included critically ill, high-risk patients. The majority of subjects suffered from septic shock, requiring both mechanical ventilation and vasopressor support to maintain hemodynamics.<\/p>\n<p style=\"text-align: justify\" data-path-to-node=\"7\"><strong>Study Outcomes<\/strong><\/p>\n<p style=\"text-align: justify\" data-path-to-node=\"8\">The primary outcome of the study (lethal outcome recorded over a 90-day period) showed that the use of sodium bicarbonate is quite &#8220;neutral&#8221; in terms of patient survival, as no statistically significant difference was recorded between the groups (62.1% in the bicarbonate group vs. 61.7% in the control group).<\/p>\n<p style=\"text-align: justify\" data-path-to-node=\"9\">In contrast, the therapeutic intervention had a significant impact on the frequency of the need for KRT: bicarbonate infusion reduced the necessity of dialysis from 50% to 35%. The time factor is also noteworthy, as clinicians in the bicarbonate group delayed the initiation of KRT nearly twice as long\u2014on average by 31 hours, whereas in the control group, this figure was only 16 hours. These data demonstrate that bicarbonate serves as an effective therapeutic &#8220;buffer&#8221; that protects the patient from premature invasive intervention.<\/p>\n<p style=\"text-align: justify\" data-path-to-node=\"10\"><strong>Study Limitations<\/strong><\/p>\n<p style=\"text-align: justify\" data-path-to-node=\"11\">Despite the methodological precision of the study, experts point to factors that somewhat limit the interpretation of the results:<\/p>\n<p style=\"text-align: justify\" data-path-to-node=\"12,0,0\">Statistical Power: The main subject of criticism is the study&#8217;s statistical power, which was designed to detect a 10% absolute reduction in mortality; such a high figure is often unrealistic in clinical practice, and this may be why the study failed to record smaller but practically significant effects.<\/p>\n<p style=\"text-align: justify\" data-path-to-node=\"12,1,0\">Study Design: The &#8220;open-label&#8221; design of the study may have influenced clinicians&#8217; decisions regarding the initiation of kidney replacement therapy, as they were aware of which patients were receiving bicarbonate.<\/p>\n<p style=\"text-align: justify\" data-path-to-node=\"13\">Current evidence provides a basis to consider sodium bicarbonate a safe therapeutic agent that effectively reduces the need for kidney replacement therapy (KRT) in patients with acidosis and acute kidney injury.<\/p>\n<p style=\"text-align: justify\">\u10ec\u10e7\u10d0\u10e0\u10dd: <a href=\"https:\/\/jamanetwork.com\/journals\/jama\/fullarticle\/2840826?guestAccessKey=bec6b83c-9f82-4f64-b631-ffea0edaf38f&amp;utm_source=twitter&amp;utm_medium=social_jama&amp;utm_term=18987464278&amp;utm_campaign=article_alert&amp;linkId=886640708\" target=\"_blank\" rel=\"noopener\">JAMA<\/a><\/p>\n<p style=\"text-align: justify\"><br style=\"font-weight: 400\" \/><br style=\"font-weight: 400\" \/><\/p>\n","protected":false},"excerpt":{"rendered":"<p>In critical care medicine, severe metabolic acidemia remains one of the most difficult challenges, as it often accelerates the progression of multi-organ failure. A sharp increase in blood acidity decreases myocardial contractility, increases resistance to vasopressors (vessel-constricting agents), and exacerbates renal dysfunction. This, in turn, creates a need for Kidney Replacement Therapy (KRT). In this [&hellip;]<\/p>\n","protected":false},"author":5,"featured_media":10610,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1641,1587],"tags":[3467,3468,3469],"class_list":["post-10609","post","type-post","status-publish","format-standard","has-post-thumbnail","category-reanimatology","category-research","tag-acidemia","tag-critical-care","tag-sodium-bicarbonate"],"acf":[],"_links":{"self":[{"href":"https:\/\/medscriptum.org\/en\/wp-json\/wp\/v2\/posts\/10609","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medscriptum.org\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medscriptum.org\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medscriptum.org\/en\/wp-json\/wp\/v2\/users\/5"}],"replies":[{"embeddable":true,"href":"https:\/\/medscriptum.org\/en\/wp-json\/wp\/v2\/comments?post=10609"}],"version-history":[{"count":1,"href":"https:\/\/medscriptum.org\/en\/wp-json\/wp\/v2\/posts\/10609\/revisions"}],"predecessor-version":[{"id":10613,"href":"https:\/\/medscriptum.org\/en\/wp-json\/wp\/v2\/posts\/10609\/revisions\/10613"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medscriptum.org\/en\/wp-json\/wp\/v2\/media\/10610"}],"wp:attachment":[{"href":"https:\/\/medscriptum.org\/en\/wp-json\/wp\/v2\/media?parent=10609"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medscriptum.org\/en\/wp-json\/wp\/v2\/categories?post=10609"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medscriptum.org\/en\/wp-json\/wp\/v2\/tags?post=10609"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}