A recent large, multicenter randomized clinical trial, likely the BICARICU-2 trial, concluded that sodium bicarbonate infusion does not reduce the 90-day all-cause mortality risk in critically ill patients with severe metabolic acidemia and moderate-to-severe acute kidney injury (AKI). This study’s findings are consistent with several other trials and reviews which have largely found no mortality benefit for sodium bicarbonate in AKI patients.
Details of Key Studies
BICARICU-2 Trial: This was a large, unblinded, multicenter randomized clinical trial that included 640 patients across 43 French intensive care units. The primary outcome was 90-day all-cause mortality. The results showed no significant difference in mortality between the group receiving sodium bicarbonate infusion to target a pH of 7.30 or higher and the control group.
A Precursor Study (likely BICARICU-1): A previous trial had suggested a potential survival benefit in a prespecified subgroup of patients with both severe metabolic acidemia and AKI as a secondary endpoint, but the primary outcome (a composite of mortality and organ dysfunction) was not significantly different. This promising subgroup result prompted the larger, more definitive BICARICU-2 trial.
Cardiac Surgery-Associated AKI Studies:
A major double-blind randomized controlled trial found that prophylactic sodium bicarbonate infusion during open heart surgery did not reduce the incidence of AKI and was associated with a possible increase in hospital mortality.
Another study focusing on contrast-induced AKI (CI-AKI) found that while sodium bicarbonate might have a borderline effect on preventing the kidney injury itself in some specific low-risk or procedure-specific cases, there was no benefit for mortality or the need for renal replacement therapy across multiple trials.
Current evidence from well-designed randomized controlled trials indicates that while sodium bicarbonate is used to manage metabolic acidosis in specific clinical contexts, routine or prophylactic infusion does not reduce the overall death risk for patients with acute kidney injury and may even be associated with potential harm in some populations. The use of sodium bicarbonate should be carefully considered, and it has not been shown to improve all-cause mortality in AKI patients.