The Nephroprotective Effects of Oral Urinary Alkalization with Blemaren® on the Outcome of Patients with Severe Myocardial Infarction
DOI:
https://doi.org/10.12970/2311-052X.2016.04.02.4Keywords:
Urinary alkalization, myocardial infarction, nephroprotection, acute kidney failure, cardiorenal syndrome, Blemaren®.Abstract
Objectives: Acute cardiac dysfunction often leads to acute kidney injury (AKI). The harmful effect of myoglobin seems to be dependent on the acidic urine pH. This study aimed to discover whether urinary alkalinization with an oral combination of sodium citrate, citric acid and potassium hydrogen carbonate (Blemaren®) reduces the prevalence of AKI in patients with severe myocardial infarction.
Methods: In this retrospective cohort study, the data from >6.600 consecutive patients between 09/2005-06/2015 were analyzed. Finally, 359 patients with severe myocardial infarction (defined as creatine kinase- levels CKmax> 80µkat/l) could be included. To prevent AKI, 307 patients received Blemaren® treatment. The following statistical methods were used to compare the cohorts: Mann- Whitney- U- test with confirmation by t-test; chi- square- test based on Pearson; statistical correlation analysis based on Pearson; linear and binary logistic regression and Log- Rank- test for comparison of cumulative survival.
Results: No significant association between the development of urea, creatinine and GFR with oral urinary alkalization using Blemaren® (p=0.898; p=0.962; p=0.645) was found. Furthermore, in subgroup analyses, Blemaren®- treatment contributed no benefit for high-risk groups (arterial hypertension, cardiogenic shock and initial renal impairment) in terms of development of AKI (p>0.05). Finally, Blemaren® treatment did not improve in-hospital survival, mid-term mortality of about 1 and 2 years or cumulative survival (all p>0.05).
Conclusion: Oral urine alkalization with Blemaren® in severe myocardial infarction to prevent AKI and to improve patients’ outcome is no longer appropriate.
References
Newsome BB, Warnock DG, McClellan WM, Herzog CA, Kiefe CI, Eggers PW, Allison JJ. Long-term risk of mortality and end-stage renal disease among the elderly after small increases in serum creatinine level during hospitalization for acute myocardial infarction. Archives of Internal Medicine 2008; 168(6): 609-16. https://doi.org/10.1001/archinte.168.6.609
Goldberg A, Hammerman H, Petcherski S, Zdorovyak A, Yalonetsky S, Kapeliovich M, Agmon Y, Markiewicz W, Aronson D. Inhospital and 1-year mortality of patients who develop worsening renal function following acute ST-elevation myocardial infarction. American Heart Journal 2005; 150(2): 330-7. https://doi.org/10.1016/j.ahj.2004.09.055
Ronco C, Haapio M, House AA, Anavekar N, Bellomo R. Cardiorenal syndrome. Journal of the American College of Cardiology 2008; 52(19): 1527-39. https://doi.org/10.1016/j.jacc.2008.07.051
Janssens U, Joannidis M. Acute cardiorenal syndroms. Med Klin Intensivmed Notfmed 2016; 111(4): 341-58. https://doi.org/10.1007/s00063-016-0159-7
Metra M, Nodari S, Parrinello G, Bordonali T, Bugatti S, Danesi R, Fontanella B, Lombardi C, Milani P, Verzura G, Cotter G, Dittrich H, Massie BM, Dei Cas L. Worsening renal function in patients hospitalised for acute heart failure: clinical implications and prognostic significance. European Journal of Heart Failure 2008; 10(2): 188-95. https://doi.org/10.1016/j.ejheart.2008.01.011
Damman K, Navis G, Smilde TDJ, Voors AA, van der Bij W, van Veldhuisen DJ, Hillege HL. Decreased cardiac output, venous congestion and the association with renal impairment in patients with cardiac dysfunction. European Journal of Heart Failure 2007; 9(9): 872-8. https://doi.org/10.1016/j.ejheart.2007.05.010
Huerta-Alardín AL, Varon J, Marik PE. Bench-to-bedside review: Rhabdomyolysis-an overview for clinicians. Critical Care 2004; 9(2): 1. https://doi.org/10.1186/cc2978
Jörres A, editor. Akutes Nierenversagen bei Intensivpatienten. Köln: Deutsche Ärzte- Verlag; 2010.
Hajjar L, Grande S, Galas F, Roquim A, Sampaio L, Auler Jr J. Risk factors and outcome of rhabdomyolysis after cardiac surgery. Critical Care 2008; 12(Suppl 2): P470.
El-Abdellati E, Eyselbergs M, Sirimsi H, Hoof VV, Wouters K, Verbrugghe W, Jorens PG. An observational study on rhabdomyolysis in the intensive care unit. Exploring its risk factors and main complication: acute kidney injury. Ann Intensive Care 2013; 3(1): 8. https://doi.org/10.1186/2110-5820-3-8
Bosch X, Poch E, Grau JM. Rhabdomyolysis and acute kidney injury. New England Journal of Medicine 2009; 361(1): 62-72. https://doi.org/10.1056/NEJMra0801327
Zager RA. Studies of mechanisms and protective maneuvers in myoglobinuric acute renal injury. Laboratory investigation; a Journal of Technical Methods and Pathology 1989; 60(5): 619-29.
Haase M, Haase-Fielitza A, Bagshawa SM, Roncoc C, Bellomoa R. Cardiopulmonary Bypass-Associated Acute Kidney Injury: A Pigment Nephropathy? Acute Kidney Injury 2007; 156: 340-53. https://doi.org/10.1159/000102125
Sehirli AO, Sener G, Satiroglu H, Ayanoglu-Dulger G. Protective effect of N-acetylcysteine on renal ischemia/reperfusion injury in the rat. J Nephrol 2003; 16(1): 75-80.
Wijeysundera DN, Beattie WS, Rao V, Granton JT, Chan CT. N-acetylcysteine for preventing acute kidney injury in cardiac surgery patients with pre-existing moderate renal insufficiency. Canadian Journal of Anesthesia 2007; 54(11): 872-81. https://doi.org/10.1007/BF03026790
Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clinical Practice 2012; 120(4): c179-c184. https://doi.org/10.1159/000339789
Atkins JL. Effect of sodium bicarbonate preloading on ischemic renal failure. Nephron 1986; 44(1): 70-4. https://doi.org/10.1159/000183915
Haase M, Haase-Fielitz A, Bellomo R, Devarajan P, Story D, Matalanis G, Reade MC, Bagshaw SM, Seevanayagam N, Seevanayagam S, Doolan L, Buxton B, Dragun D. Sodium bicarbonate to prevent increases in serum creatinine after cardiac surgery: A pilot double-blind, randomized controlled trial. Critical Care Medicine 2009; 37(1): 39-47. https://doi.org/10.1097/CCM.0b013e318193216f
Ketteler M, Biggar PH. Kardiorenales Syndrom. Der Nephrologe 2010; 5(1): 49. https://doi.org/10.1007/s11560-009-0338-0
de Meijer, Arthur R, Fikkers BG, de Keijzer, Marinus H, van Engelen, Baziel GM, Drenth JPH. Serum creatine kinase as predictor of clinical course in rhabdomyolysis: a 5-year intensive care survey. Intensive Care Medicine 2003; 29(7): 1121-5. https://doi.org/10.1007/s00134-003-1800-5
Palomba H, Castro I de, Neto AL, Lage S, Yu L. Acute kidney injury prediction following elective cardiac surgery: AKICS Score. Kidney International 2007; 72(5): 624-31. https://doi.org/10.1038/sj.ki.5002419
Boldt J, Hammermann H, Hempelmann, G. Prevention and therapy of acute kidney failure in heart surgery and following trauma Klin Anasthesiol Intensivther 1993; 45: 61-70. https://doi.org/10.1007/978-3-642-78343-2_7
Heringlake M, Heinze H, Schubert M, Nowak Y, Guder J, Kleinebrahm M, Paarmann H, Hanke T, Schön J. A perioperative infusion of sodium bicarbonate does not improve renal function in cardiac surgery patients: a prospective observational cohort study. Critical Care 2012; 16(4): 1. https://doi.org/10.1186/cc11476
McGuinness SP, Parke RL, Bellomo R, Van Haren, Frank MP, Bailey M. Sodium Bicarbonate Infusion to Reduce Cardiac Surgery-Associated Acute Kidney Injury: A Phase II Multicenter Double-Blind Randomized Controlled Trial. Critical Care Medicine 2013; 41(7): 1599-607. https://doi.org/10.1097/CCM.0b013e31828a3f99
Burns KEA, Chu MWA, Novick RJ, Fox SA, Gallo K, Martin CM, Stitt LW, Heidenheim AP, Myers ML, Moist L. Perioperative N-acetylcysteine to prevent renal dysfunction in high-risk patients undergoing cabg surgery: a randomized controlled trial. JAMA 2005; 294(3): 342-50. https://doi.org/10.1001/jama.294.3.342
