Findings<\/strong> In this multicenter randomized clinical trial that included 640 patients, sodium bicarbonate infusion was not associated with lower day 90 all-cause mortality (195 of 314 patients in the bicarbonate group and 193 of 313 patients in the control group).<\/p>\n\n\n\n Meaning<\/strong> Sodium bicarbonate infusion does not improve day 90 all-cause mortality.<\/a><\/p>\n\n\n\n Abstract<\/p>\n\n\n\n (opens in new tab)<\/a><\/p>\n\n\n\n Sodium Bicarbonate for Severe Metabolic Acidemia and Acute Kidney Injury<\/p>\n\n\n\n Visual Abstract.<\/p>\n\n\n\n <\/a><\/a><\/p>\n\n\n\n Importance<\/strong> The effect of sodium bicarbonate infusion on outcome in patients with severe metabolic acidemia and moderate to severe acute kidney injury is unknown.<\/p>\n\n\n\n Objective<\/strong> To determine whether sodium bicarbonate infusion is associated with day 90 all-cause mortality in patients with severe metabolic acidemia and moderate to severe acute kidney injury.<\/p>\n\n\n\n Design, Setting, and Participants<\/strong> Randomized, open-label, clinical trial conducted with 640 patients in 43 French intensive care units from October 6, 2019, to December 19, 2023, with 90-day follow-up. The last date of follow-up was June 17, 2024. Adults with severe metabolic acidemia (defined as pH \u22647.20) and moderate to severe acute kidney injury were enrolled.<\/p>\n\n\n\n Intervention<\/strong> Patients were randomized 1:1 to receive either intravenous sodium bicarbonate infusion or no sodium bicarbonate to target an arterial pH of 7.30 or higher.<\/p>\n\n\n\n Main Outcomes and Measures<\/strong> The primary outcome was day 90 all-cause mortality. Secondary outcomes included day 28 and day 180 all-cause mortality; use of organ support therapy, vasopressors, or invasive mechanical ventilation; intensive care unit and hospital length of stay; intensive care unit\u2013acquired infections; fluid balance; day-7 Sequential [Sepsis-related] Organ Failure Assessment score (6 organ systems\u2019 function is evaluated and scored from 0 [no dysfunction] to 4 [failure]; total score ranges from 0 [normal] to 24 [maximum failure]); and major adverse kidney events on day 90.<\/p>\n\n\n\n Results<\/strong>\u00a0\u00a0Among 640 randomly assigned patients, 627 were analyzed (313 in the control group and 314 in the bicarbonate group). The median age was 67 years (IQR, 59-74 years); 194 of 314 patients (62%) in the bicarbonate group and 185 of 313 controls (59%) were male. In the primary analysis, day 90 all-cause mortality was 195 of 314 patients (62.1%) in the bicarbonate group and 193 of 313 (61.7%) in the control group (absolute difference, 0.4; 95% CI, \u22127.2 to 8.0;\u00a0P<\/em>\u2009=\u2009.91). There was no evidence of a group effect on day 28 or day 180 all-cause mortality. Among 18 secondary outcomes, kidney replacement therapy was used in 109 of 314 (35%) bicarbonate group patients and 157 of 313 (50%) controls (absolute difference, \u221215.5; 95% CI, \u221223.1 to \u22127.8). No evidence of a group effect was found on other secondary outcomes, including adverse events.<\/p>\n\n\n\n Conclusions and Relevance<\/strong> For patients with severe metabolic acidemia and moderate to severe acute kidney injury, intravenous sodium bicarbonate did not affect mortality.<\/p>\n\n\n\n![\"\"\/](\"https:\/\/cdn.jamanetwork.com\/ama\/content_public\/journal\/jama\/0\/joi250088va_1761578929.56214.png?Expires=1764798345&Signature=dOgjkhMQ1KHCAjkEMvglgC8tx0MUiP~XicbyE5XHjaJLPvpcBpxughcvyZ1IADLjZcAHS6Bd2dzb1uAJcUAbGMT0Z-DkwO2-X-VnRoSgII3BZsvxwtly6SJwmBFJvzZ5vu5Ivqmu4uSNx-iCFo-ZMjLdmhHD6zE1QQyfkGYlHdYu3ZxaTzIEGebv7e4vytxIV7XigXMPWUDUT~S7SakEatvgxSGN2z1Ooz0h6V41UKxvsLFR3raXN02yBinF6beLG3LcPa-ASow1KdlXJFeKtjpa5STQiRtMoW5OIxCU0p0pXtU79tUxFzo27mX3JbthDiDMVqbA64OX-FrKySGyIA__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA\")
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