Bicarbonate Therapy in Renally Compromised Critically Ill Patients with Metabolic Acidosis: Study of Clinical Outcomes and Mortality Rate

Figures & data

Table 1 Characteristics of Study Patients

Demographic Variables		Frequency (%)
Age	<40 years	18 (22.2)
	40–60 years	24 (29.6)
	>60 years	39 (48.1)
Gender	Male	51 (63)
	Female	30 (37)
Weight	<70 kg	50.1 (61.9)
	>70 kg	49.9 (38.1)
CKD Stage	G1	4 (5.1)
	G2	9 (11.4)
	G3a	1 (1.3)
	G3b	6 (7.6)
	G4	9 (11.4)
	G5	50 (66.3)
Comorbidities	Hypertension	48 (59.3)
	Diabetes	45 (55.6)
	Ischemic Heart Disease	19 (23.5)
	Liver disease	5 (6.2)
	Renal Disease	57 (70.3)
	Recent Infection disease	2 (2.5)
	Surgery	9 (11.1)
Dialysis Status	Non-dialysis	34 (42)
	Pre-dialysis	27 (33.3)
	Post-dialysis (1st time)	20 (24.7)
Edema	Yes	44 (62.9)
	No	37 (37.1)
Blood Glucose (Random)	Normal	23 (35.4)
	High	40 (61.5)
Blood Glucose (Fasting)	Normal	20 (38.5)
	High	32 (61.5)
Number of Comorbidities	<3 comorbidities	53 (65.4)
	>3 comorbidities	18 (22.2)
	No comorbidities	10 (12.3)
Stay in ICU	<3 days	14 (17.3)
	4–10 days	54 (66.6)
	>10 days	13 (16.1)
Stay in Hospital	<3 days	6 (7.4)
	4–10 days	53 (65.4)
	>10 days	22 (27.2)

Table 2 Serum Creatinine Values for the Study Patients

	Initial Value (mg/dL)	Final Value (mg/dL)	Difference (mg/dL)
Mean±SD	6.27±6.35	4.70±3.24	−1.65±5.78
Minimum	0.28	0.79	−32.64
Maximum	45.44	22.25	17.69

Table 3 Clinical Outcomes of the Disease

Outcomes	Frequency (%)
Discharge	44 (54.3)
Death	37 (45.7)

Table 4 Association of Progression of Kidney Diseases and Clinical Outcomes

CKD Stages	Deaths	Recovered	P-value
	N (%)	N (%)
G1	2 (50)	2 (50)	0.817
G2	4 (44.4)	5 (55.6)
G3a	1 (100)	0 (0)
G3b	3 (50)	3 (50)
G4	5 (55.6)	4 (44.4)
G5	20 (40)	30 (60)
AKI stages	0.714
AKI Stage 1		5 (50)	5 (50)
AKI Stage 2		6 (66.7)	3 (33.3)
AKI Stage 3		4 (50)	4 (50)

Table 5 Association of Laboratory Parameters with Clinical Outcomes

Test	Effect	Count	Deaths	Recovered	P-value
		N (%)	N (%)	N (%)
Sodium	Hyponatremia	24 (30.8)	8 (10.3)	16 (20.5)	0.113*
	Hypernatremia	22 (28.2)	14 (17.9)	8 (10.3)	0.097**
	Normal	32 (41)	18 (23.1)	14 (17.9)
Calcium	Hypocalcemia	56 (77.8)	30 (41.7)	26 (36.1)	0.105*
	Hypercalcemia	1 (1.4)	1 (1.4)	0 (0)	0.545**
	Normal	15 (20.8)	4 (5.6)	11 (15.3)
Magnesium	Hypomagnesemia	21 (35)	14 (23.3)	7 (11.7)	0.117*
	Hypermagnesemia	9 (15)	6 (10)	3 (5)	0.911**
	Normal	30 (50)	12 (20)	18 (30)
Urea	High	76 (95)	32 (94.1)	42 (95.5)	0.791*
	Normal	4 (5)	2 (5.9)	2 (4.5)
Serum Creatinine	Normal	5 (6.3)	2 (5.7)	3 (6.8)	0.841*
	High	75 (93.8)	33 (97.3)	41 (93.2)
Potassium	Normal	26 (32.9)	13 (16.5)	13 (16.5)	0.144*
	Hyperkalemia	33 (41.8)	11 (13.9)	22 (27.8)	0.044**
	Hypokalemia	26 (32.9)	12 (15.2)	8 (10.1)
Blood Pressure	Baseline	24 (29.6)	3 (3.7)	17 (21.0)
	Increase in BP from Baseline	27 (33.3)	10 (12.3)	6 (7.4)	<0.001*
	Decrease in BP from Baseline	30 (37)	24 (29.6)	21 (25.9)	0.116**

Notes: *Chi Square **ANOVA.

Table 6 Association of Various Co-Morbid Conditions with Clinical Outcomes

Test	Effect	Deaths	Recovered	P-value
		N (%)	N (%)
Hypertension	Yes	21 (43.8)	27 (56.3)	0.423
	No	16 (48.5)	17 (51.5)
Diabetes	Yes	21 (46.7)	24 (53.3)	0.510
	No	16 (44.4)	20 (55.6)
Ischemic Heart Disease	Yes	12 (63.2)	7 (36.8)	0.069
	No	25 (40.3)	37 (59.7)
Liver Disease	Yes	4 (80)	1 (20)	0.130
	No	33 (43.4)	43 (56.6)
Renal Disease	Yes	23 (40.4)	34 (59.6)	0.108
	No	14 (58.3)	10 (41.7)
Recent infectious disease	Yes	0 (0)	2 (100)	0.292
	No	37 (46.8)	42 (53.2)
Surgery	Yes	4 (44.4)	5 (55.6)	0.611
	No	33 (45.8)	39 (54.2)

Table 7 Association of Various Complications of CKD with Clinical Outcomes

Test	Effect	Deaths	Recovered	P-value
		N (%)	N (%)
Edema	Yes	18 (46.2)	21 (53.8)	0.541
	No	17 (44.7)	21 (55.3)
Hypoxia	Yes	17 (60.7)	11 (39.3)	0.029
	No	17 (35.4)	31 (64.6)
Anemia	Yes	31 (44.9)	38 (55.1)	0.612
	No	5 (45.5)	6 (54.5)
Hyperlactemia	Yes	26 (86.7)	4 (13.3)	0.000
	No	10 (23.3)	33 (76.7)
Heart Failure	Yes	31 (88.6)	4 (11.4)	0.000
	No	5 (11.6)	38 (88.4)
Multiple organ failure	Yes	24 (75)	8 (25)	0.000
	No	11 (24.4)	34 (75.6)
	No	33 (45.8)	39 (54.2)

Table 8 Mortality Rate with Various Treatment Therapies

Treatment	Total N (%)	Death	Recovered	P-value
Sodium bicarbonate alone	8 (9.87)	3 (37.5)	5 (62.5)	0.498*
Sodium bicarbonate + Sodium chloride	73 (90.12)	39 (53.4)	34 (46.5)

Notes: *P-value through Fisher's exact test.

Table 9 Number of Medicines of Various Categories Prescribed

Total Medication	Mean±SD
Total medicines prescribed	18.75±6.244
Total antibiotics prescribed	2.96±1.76
No of antihypertensive drugs prescribed	1.37±1.346
No of antidiabetic drugs	0.73±0.689
No of immune suppressant drugs prescribed	0.28±0.506
No of IV fluids prescribed	2.25±1.090
No of injectable drugs prescribed	13.69±5.426
No of interacting drugs	4.91±2.599
No of drug interactions	3.22±1.830

Table 10 Effect of Medications on Mortality Rate

Treatments	Died	Recovered	P-value
Drugs interfering with the excretion of creatinine	5 (13.5)	2 (4.5)	0.152
Drugs used for management of BP	27 (73.0)	30 (68.2)	0.638
Drugs used for managing anemia	33 (89.2)	33 (75.0)	0.102
Drugs used for prevention of AKI	36 (97.3)	43 (97.7)	0.901
Drugs for MBD	27 (73.0)	36 (81.8)	0.340
Drugs for management of lipid disorder	10 (27.0)	6 (13.6)	0.132
Antibiotics	37 (100.0)	40 (90.9)	0.060
Anti-ulcer drugs	33 (89.2)	41 (93.2)	0.524
Drugs for nausea and vomiting	14 (37.8)	24 (54.5)	0.133
Drugs for pain and fever	31 (83.8)	30 (68.2)	0.105

Table 11 Impact of Drug–Drug Interactions on Clinical Outcomes

Type of Drug–Drug Interaction	Total N (%)	Death	Recovered	P-value
No interaction	7 (8.6)	2 (5.4)	5 (11.4)	0.044
Minor interaction	6 (7.4)	3 (8.1)	3 (6.8)
Significant (needs monitoring)	19 (23.5)	4 (10.8)	15 (34.1)
Serious (contraindicated)	49 (60.5)	28 (75.7)	21 (47.7)