A randomized trial found sodium bicarbonate did not lower 30-day risks of death or major kidney events in critically ill patients despite quick acidemia correction.Previous open-label trials suggested potential renal benefits, but this double-blind study found no difference in outcomes.The treatment also showed no benefit in prespecified subgroups, though power was limited.
Sodium bicarbonate to correct metabolic acidosis in critically ill patients on vasopressors did not lower risks of major kidney outcomes, the randomized, double-blind SODa-BIC trial showed.
While the intervention rapidly corrected acidemia, there was no difference in the rate of major adverse kidney events -- including death, use of renal-replacement therapy, or persistent renal dysfunction -- in patients who received sodium bicarbonate versus placebo by day 30 (40.2% vs 39.4%, P=0.78), reported Ary Serpa Neto, MD, PhD, MSc, of Monash University in Melbourne, Australia, and colleagues.
Individually, rates of renal-replacement therapy (16.8% vs 20.9% for placebo) and in-hospital mortality (25.4% vs 24%) didn't differ between groups at day 30, the authors wrote in the New England Journal of Medicine.
The findings were simultaneously presented at the 2026 Critical Care Reviews Meeting in Belfast, Ireland.
