Effect of sodium bicarbonate infusion in off-pump coronary artery bypass grafting in patients with renal dysfunction

Area of Science:

• Nephrology
• Cardiovascular Surgery
• Critical Care Medicine

Background:

• Acute kidney injury (AKI) is a significant complication after cardiac surgery, increasing patient morbidity and mortality.
• Patients with chronic kidney disease (CKD) are at higher risk for AKI during cardiovascular procedures.
• Off-pump coronary artery bypass grafting (OP-CABG) aims to reduce cardiac surgical risks, but AKI remains a concern.

Purpose of the Study:

• To evaluate the efficacy of sodium bicarbonate (NaHCO3) in preventing perioperative AKI.
• To compare the incidence of AKI in CKD patients undergoing OP-CABG with and without NaHCO3 supplementation.
• To assess the renal protective effect of NaHCO3 in this patient population.

Main Methods:

• Prospective study of 60 non-dialysis CKD patients (GFR ≤60 ml/min/1.73 m²) undergoing elective OP-CABG.
• Randomized allocation to receive either NaHCO3 infusion or 0.9% NaCl.
• Inclusion of a control group of 30 patients with normal renal function.

Main Results:

• The incidence of Stage-1 AKI was 20% in the NaHCO3 group, 33.3% in the NaCl group, and 20% in the normal renal function group.
• NaHCO3 infusion reduced Stage-1 AKI by approximately 40% compared to NaCl.
• No patients required renal replacement therapy, and no mortality was observed in any group.

Conclusions:

• Perioperative NaHCO3 supplementation significantly reduced the incidence of Stage-1 AKI in CKD patients undergoing OP-CABG.
• The renal protective effect of NaHCO3 was comparable to that observed in patients with normal kidney function.
• Larger studies may be needed to confirm the statistical significance of NaHCO3's renal protective benefits in OP-CABG.