Kidney Week

Abstract: TH-PO0087

Intravenous Sodium Bicarbonate in Critically Ill Adults with Metabolic Acidosis: A Systematic Review and Meta-Analysis

Session Information

• Fluid, Electrolyte, and Acid-Base Disorders: Clinical Research
  October 22, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Fluid, Electrolytes, and Acid-Base Disorders

• 1102 Fluid, Electrolyte, and Acid-Base Disorders: Clinical

Authors

• Kashani, Mehdi, Mayo Clinic Minnesota, Rochester, Minnesota, United States

Mehdi Kashani, MD

• Domecq Garces, Juan Pablo, Mayo Clinic Minnesota, Rochester, Minnesota, United States

Juan Pablo Domecq Garces, MD

• Kashani, Kianoush, Mayo Clinic Minnesota, Rochester, Minnesota, United States

Kianoush Kashani, MD, MS, FASN

Background

Metabolic acidosis is common in critically ill patients and is associated with increased mortality. Intravenous sodium bicarbonate (SB) is frequently used to correct acidemia, but its clinical benefit remains uncertain.

Methods

We performed a systematic review and meta-analysis according to PRISMA guidelines with PROSPERO registration (CRD420251158090). Electronic databases were searched through January 2026 for randomized and observational studies evaluating intravenous SB therapy in critically ill adults with metabolic acidosis. The primary outcome was all-cause mortality and the secondary outcome was kidney replacement therapy (KRT) utilization.

Results

Fourteen studies involving 16,140 patients were included, comprising 4 randomized trials and 10 observational studies. SB therapy was associated with lower all-cause mortality in the overall analysis (HR 0.88, 95% CI 0.79-0.98; I2 = 61.2%), although this was not significant in randomized trials alone (HR 0.76, 95% CI 0.54-1.06; I2 = 51%). SB therapy was associated with reduced KRT utilization (HR 0.65, 95% CI 0.57-0.74; I2 = 0%). Trial sequential analysis suggested insufficient evidence for mortality benefit but more robust evidence for reduced KRT utilization. Certainty of evidence was very low for mortality and moderate for KRT utilization.

Conclusion

Intravenous SB therapy may reduce KRT utilization in critically ill patients with metabolic acidosis; however, evidence for mortality benefit remains uncertain. Further randomized trials are needed to identify patients most likely to benefit and to define optimal treatment strategies.

Mortality Forest Plot

RRT Forest Plot