Sodium bicarbonate infusion for severe metabolic acidemia may lower the risk of death or organ failure among intensive care unit (ICU) patients with acute kidney injury (AKI), according to the findings from a phase 3 randomized controlled trial.

Among ICU patients with AKI (Acute Kidney Injury Network [AKIN] scores of 2 or 3 at study enrollment), a significantly smaller proportion of patients who received sodium bicarbonate compared with those who did not experienced the study’s primary composite outcome of death from any cause by day 28 and at least 1 organ failure by day 7 (70% vs 82%), Samir Jaber, MD, of Montpellier University Hospital in Montpellier, France, and colleagues reported in The Lancet (2018;392:31-40). Further, the need for renal replacement therapy (RRT) during the ICU stay was significantly lower among sodium bicarbonate recipients than controls (51% vs 73%).

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The trial enrolled 389 patients with severe metabolic acidemia, of whom 182 had AKIN scores of 1 to 2. Investigators randomly assigned 195 patients to receive sodium bicarbonate and 194 did not (controls). The treatment goal was a blood pH of 7.3 or higher. In the overall study population, sodium bicarbonate infusion had no significant effect on the primary composite outcome, but was associated with a significantly less need for RRT during the ICU stay (35% vs 52%).


Jaber S, Paugam C, Futier E, et al. Sodium bicarbonate therapy for patients with severe metabolic acidaemia in the intensive care unit (BICAR-ICU): a multicentre, open-label, randomised controlled, phase 3 trial. Lancet. 2018;392:31-40.