{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T21:55:38Z","timestamp":1793310938123,"version":"4.5.0"},"reference-count":33,"publisher":"American Medical Association (AMA)","issue":"22","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA"],"published-print":{"date-parts":[[2025,12,9]]},"abstract":"\n Importance<\/jats:title>\n The effect of sodium bicarbonate infusion on outcome in patients with severe metabolic acidemia and moderate to severe acute kidney injury is unknown.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Intervention<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Among 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;\n P<\/jats:italic>\n \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.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n For patients with severe metabolic acidemia and moderate to severe acute kidney injury, intravenous sodium bicarbonate did not affect mortality.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n ClinicalTrials.gov Identifier:\n NCT04010630<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jama.2025.20231","type":"journal-article","created":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T13:30:44Z","timestamp":1761744644000},"page":"2000","source":"Crossref","is-referenced-by-count":55,"title":["Sodium Bicarbonate for Severe Metabolic Acidemia and Acute Kidney Injury"],"prefix":"10.1001","volume":"334","author":[{"given":"Boris","family":"Jung","sequence":"first","affiliation":[{"name":"Medical ICU, Lapeyronie University Hospital, PhyMedExp, Montpellier University, Montpellier, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mathieu","family":"Jabaudon","sequence":"additional","affiliation":[{"name":"Centre Hospitalier Universitaire (CHU), Departement Anesthesie et R\u00e9animation, Estaing Hospital, Clermont-Ferrand, France"},{"name":"Universit\u00e9 Clermont Auvergne, CNRS, INSERM U-1103, Clermont-Ferrand, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Audrey","family":"De Jong","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, Department of Anesthesiology and Critical Care Medicine B (DAR B), Saint-Eloi Hospital, Montpellier, France"},{"name":"University Teaching Hospital of Montpellier, PhyMedExp, Montpellier, INSERM U1046, Montpellier, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurent","family":"Bitker","sequence":"additional","affiliation":[{"name":"Medical Intensive Care Unit, La Croix Rousse Hospital, Lyon, France"},{"name":"Lyon University Hospital, 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