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Association between mortality and replacement solution bicarbonate concentration in continuous renal replacement
Kianoush Kashani1,2, Charat Thongprayoon1, Wisit Cheungpasitporn1
1Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, United States of America.
Plos One
|September 29, 2017
Summary
High bicarbonate concentration in continuous venovenous hemofiltration (CVVH) replacement fluid is linked to increased mortality in critically ill patients with acute kidney injury (AKI). Further prospective studies are needed to confirm these findings.
Area of Science:
- Nephrology
- Critical Care Medicine
- Biochemistry
Background:
- Bicarbonate supplementation has known adverse effects in acidemia.
- High bicarbonate concentration in continuous venovenous hemofiltration (CVVH) replacement solutions may increase mortality.
Purpose of the Study:
- To investigate the association between high bicarbonate concentration in CVVH replacement solutions and mortality in critically ill patients with Stage III acute kidney injury (AKI).
Main Methods:
- A propensity score-matched historical cohort study of 287 adult critically ill patients with Stage III AKI requiring CVVH.
- Patients received either 22 mEq/L or 32 mEq/L bicarbonate solution for CVVH.
- Primary outcome was in-hospital and 90-day mortality rates.
Main Results:
- The 32 mEq/L bicarbonate group (n=68) had higher in-hospital (HR=1.94) and 90-day mortality (HR=1.50) compared to the 22 mEq/L group (n=219) after adjustment.
- Significant increases in hospital (p=.03) and 90-day mortality (p=.04) were observed between the 22 vs. 32 mEq/L groups post-matching.
Conclusions:
- High bicarbonate concentration in CVVH replacement solutions is independently associated with increased mortality.
- These findings highlight potential risks of high bicarbonate use in CVVH for AKI patients.
- Prospective studies are recommended to validate these associations.
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