Bicarbonate did not prevent major adverse kidney events in acidotic shock

The edition in brief

SODa-BIC randomised 500 vasopressor-dependent ICU patients with metabolic acidosis to sodium bicarbonate or placebo; major adverse kidney events at 30 days were 40.2% vs 39.4% (difference 1.2 points, 95% CI −7.1 to 9.4), and renal replacement therapy (16.8% vs 20.9%) did not differ significantly. A meta-analysis of 153 cohorts with over 132,000 peritoneal dialysis patients estimated global peritonitis incidence at 0.31 episodes per patient-year, with the South-East Asia region at 0.41, above the ISPD benchmark of 0.40, and Gram-positive organisms commonest. A meta-analysis of four observational studies (72,980 men) associated androgen deprivation therapy with AKI (OR 1.34). A review of 203 reports found time-zero biopsy features such as vascular injury and glomerulosclerosis were associated with delayed graft function and graft failure, but all evidence was very low certainty and does not support biopsy as a stand-alone discard rule. In five men with AVPR2-related congenital vasopressin resistance, two weeks of fluconazole did not reduce urine output or improve concentrating ability.