***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: Introduction Cardiac-surgery-associated-acute-kidney-injury ( CSA-AKI ) is associated with increased morbidity and mortality . Recent data from patients undergoing on-pump coronary artery bypass grafting suggest that a perioperative infusion of sodium-bicarbonate may decrease the incidence of CSA-AKI . The present study aims to analyze the renoprotective effects of a 24h infusion of sodium-bicarbonate in a large , heterogeneous group of cardiac surgical patients Methods Starting in 4/2009 , all patients undergoing cardiac surgery at our institution were enrolled in a prospect i ve trial analyzing the relationship between preoperative cerebral oxygen saturation and postoperative organ dysfunction . We used this prospect ively sample d data set to perform a cohort analysis of the renoprotective efficiency of a 24h continuous perioperative infusion of sodium-bicarbonate on the incidence of CSA-AKI that was routinely introduced in 7/2009 . After exclusion of patients with endstage chronic kidney disease , off-pump procedures , and emergency cases , perioperative changes in renal function  were assessed in 280 patients treated with a perioperative infusion of 4 mmol sodium-bicarbonate / kg body weight in comparison with a control cohort of 304 patients enrolled from April to June in this prospect i ve cohort study .Postoperative  changes in urine flow , plasma creatinine , estimated creatinine clearance , and the need for renal replacement therapy were determined according to AKI injury network criteria . Concomitantly , hemodynamics , treatments , complications , and clinical outcomes were recorded . Univariate statistical analyses were performed para- and nonparametrically , as appropriate . Results With the exception of a lower prevalence of a history of myocardial infa rct ion and a lower preoperative use of intravenous heparin in the bicarbonate-group , no significant between group differences in patient demographics , surgical risk , type , and duration of surgery were observed . Patients in the bicarbonate group had a lower mean arterial blood pressure after induction of anesthesia , needed more fluids , more vasopressors , and a longer treatment time in the high dependency unit . Despite a higher postoperative diuresis , no differences in the incidence of AKI grade 1 to 3 and the need for renal replacement were observed . Conclusions Routine perioperative administration of sodium bicarbonate failed to improve postoperative renal function in a large population of cardiac surgical patients " Recommendations for the management of  crush victims in mass disasters " aims to assist medics , paramedics and rescue team members who provide care during disasters . Development of the recommendations followed an explicit process of literature review and , also internet and face-to-face discussion s. The chapters cover medical and logistic measures , to be taken both at the disaster field and in the hospitals , to cope with the problems created by a catastrophe . Recommendations were based on retrospective analyses and case reports on past disasters , and also expert judgment or opinion . Since there are no r and omized controlled trials , no GRADE approach was used to develop the recommendations , and no strengths of recommendations or levels of evidence are provided CONTEXT Contrast-induced nephropathy remains a common complication of radiographic procedures . Pretreatment with sodium bicarbonate is more protective than sodium chloride in animal models of acute ischemic renal failure . Acute renal failure from both ischemia and contrast are postulated to occur from free-radical injury . However , no studies in humans or animals have evaluated the efficacy of sodium bicarbonate for prophylaxis against contrast-induced nephropathy . OBJECTIVE To examine the efficacy of sodium bicarbonate compared with sodium chloride for preventive hydration before and after radiographic contrast . DESIGN , SETTING , AND PATIENTS A prospect i ve , single-center , r and omized trial conducted from September 16 , 2002 , to June 17 , 2003 , of 119 patients with stable serum creatinine levels of at least 1.1 mg/dL ( > or = 97.2 micromol/L ) who were r and omized to receive a  154-mEq/L infusion of either sodium chloride ( n = 59 ) or sodium bicarbonate ( n = 60 ) before and after iopamidol administration ( 370 mg iodine/mL ) . Serum creatinine levels were measured at baseline and 1 and 2 days after contrast . INTERVENTIONS Patients received 154 mEq/L of either sodium chloride or sodium bicarbonate , as a bolus of 3 mL/kg per hour for 1 hour before iopamidol contrast , followed by an infusion of 1 mL/kg per hour for 6 hours after the procedure . MAIN OUTCOME MEASURE Contrast-induced nephropathy , defined as an increase of 25 % or more in serum creatinine within 2 days of contrast . RESULTS There were no significant group differences in age , sex , incidence of diabetes mellitus , ethnicity , or contrast volume . Baseline serum creatinine was slightly higher but not statistically different in patients receiving sodium bicarbonate treatment ( mean [ SD ] , 1.71 [ 0.42 ] mg/dL [ 151.2 [ 37.1 ] micromol/L ] for sodium chloride and 1.89 [ 0.69 ] mg/dL [ 167.1 [ 61.0 ] micromol/L ] for sodium bicarbonate ; P = .09 ) . The primary end point of contrast-induced nephropathy occurred in 8 patients ( 13.6 % ) infused with sodium chloride but in only 1 ( 1.7 % ) of those receiving sodium bicarbonate ( mean difference , 11.9 % ; 95 % confidence interval [ CI ] , 2.6%-21.2 % ; P = .02 ) . A follow-up registry of 191 consecutive patients receiving prophylactic sodium bicarbonate and meeting the same inclusion criteria as the study result ed in 3 cases of contrast-induced nephropathy ( 1.6 % ; 95 % CI , 0%-3.4 % ) . CONCLUSION Hydration with sodium bicarbonate before contrast exposure is more effective than hydration with sodium chloride for prophylaxis of contrast-induced renal failure In a double-blinded r and omized controlled trial , Anja Haase-Fielitz and colleagues find that an infusion of sodium bicarbonate  during open heart surgery did not reduce the risk for acute kidney injury , compared with saline control Background Acute kidney injury ( AKI ) requiring renal replacement therapy ( RRT ) is associated with high in-hospital morbidity and mortality in critically ill patients . Long-term outcomes have received little attention . Methods The aim of this study was to characterize AKI – chronic kidney disease ( CKD ) nexus in critically ill patients with AKI ( RIFLE class F ) . We performed a single-centre prospect i ve observational study of 425 consecutive critically ill patients with AKI requiring RRT . None of these patients had pre-existing kidney disease . Primary outcomes were vital status and renal function at hospital discharge and at 5 and 10 years of follow-up . Results The overall in-hospital mortality of the study cohort was 47 % , the mortality rates at 1 , 5 and 10 years were 65 , 75 and 80 % , respectively . At hospital discharge , recovery of renal function was complete in 56 % of survivors . None of these patients developed CKD during follow-up . Ninety percent of the 100 survivors with partial recovery of renal function had ongoing CKD during long-term follow-up . CKD progressed to end-stage renal disease ( ESRD ) in 12 patients ( 3 % of the cohort or 5 % of survivors ) . The patients with post-AKICKD had a higher prevalence of hypertension , a higher rate of fatal cardiac diseases and a higher all-cause death rate . Conclusion Long-term survival of critically ill patients with AKI requiring RRT is poor and determined by the development of de novo CKD . There is a need for close follow-up of patients surviving AKI to prevent progressive CKD and to reduce associated lethal cardiac events Iodine and gadolinium-based contrast induced nephropathy is the third leading cause of hospital-acquired acute kidney injury . It is essentially observed in patients with defined risk factors and is associated with increased morbidity and mortality . The prevention of contrast induced nephropathy consists in volume expansion through intravenous sodium chloride 0.9 % or sodium bicarbonate 1.4 % . Comparative r and omized controlled trials appear to show a benefit in favor of sodium bicarbonate over saline fluids . According to last evidence , N-acetylcysteine does not provide additional benefit over intravenous fluids BACKGROUND There is controversy about the prophylactic measures proposed for the prevention of  contrast-induced nephropathy ( CIN ) .  We aim to compare the efficacy of the combination of sodium bicarbonate and isotonic saline and that of isotonic saline alone in preventing CIN . STUDY DESIGN R and omized double-blind controlled trial . SETTING & PARTICIPANTS 265 consecutive patients 18 years or older with a serum creatinine level of 1.5 mg/dL or greater undergoing elective coronary angiography from August 2007 to June 2008 in Tehran Heart Center , Tehran , Iran . INTERVENTION Study participants were r and omly assigned to receive either 75 mL of 8.4 % sodium bicarbonate added to 1 L of isotonic saline ( n = 135 ) or isotonic saline alone ( n = 130 ) as a bolus of 3 mL/kg for 1 hour before contrast injection , followed by an infusion of 1 mL/kg/h for 6 hours after the procedure . OUTCOMES & MEASUREMENTS The primary end point was an absolute ( > or=0.5 mg/dL ) or relative ( > or=25 % ) increase in serum creatinine level 48 hours after the procedure ( CIN ) . RESULTS There were no significant differences between the bicarbonate and saline groups regarding baseline demographic and biochemical characteristics , including baseline serum creatinine level ( 1.63 + /- 0.32 [ SD ] versus 1.66 + /- 0.50 mg/dL ) , baseline glomerular filtration rate ( 46.4 + /- 12 versus 45.4 + /- 12 mL/min/1.73 m(2 ) ) , and baseline urine pH ( 5.42 + /- 0.6 versus 5.46 + /- 0.8 ) . Nine patients ( 7.4 % ) receiving sodium bicarbonate developed CIN as opposed to 7 patients ( 5.9 % ) in the saline group , which was not statistically different ( odds ratio , 1.26 ; 95 % confidence interval , 0.45 to 3.50 ; P = 0.6 ) . LIMITATIONS The trial did not follow up participants to assess need for dialysis and mortality rate . CONCLUSION The combination therapy of sodium bicarbonate plus saline does not offer additional benefits over hydration with saline alone in the prevention of CIN Objectives : Cardiac surgery – associated acute kidney injury occurs in up to 50 % of patients and is associated with increased mortality and morbidity . This study aim ed to discover if perioperative urinary alkalinization with sodium bicarbonate infusion reduces the prevalence of cardiac surgery – associated acute kidney injury . Design : This study was a phase IIb multicenter double-blind r and omized controlled trial . Setting : This study was conducted in three tertiary hospitals in New Zeal and and Australia . Patients : A total of 427 patients scheduled to undergo elective cardiac surgery , who were at increased risk of development of cardiac surgery – associated acute kidney injury using recognized risk factors . Measurements and Main Results : Patients were r and omly allocated to receive either sodium bicarbonate ( n = 215 ) or sodium chloride ( n = 212 ) infusion , commencing at the start of anesthesia , in a dose of 0.5 mEq/kg/hr for the first hour and then 0.2 mmol/kg/hr for 23 hours . The primary outcome measure was the number of patients with development of cardiac surgery – associated acute kidney injury , defined as an increase in creatinine greater than 25 % or 0.5 mg/dL ( 44 µmol/L ) from baseline to peak value within the first five postoperative days . Significant differences among the groups in both plasma and urinary biochemistry were achieved 6 hours after commencement of the infusion , and these changes persisted for more than 24 hours . A total of 100 out of 215 patients ( 47 % [ 95 % CI , 40%–53 % ] ) in the sodium bicarbonate group and 93 of 212 patients ( 44 % [ 95 % CI , 37%–51 % ] ) in the sodium chloride group with development of acute kidney injury within the first five postoperative days ( p = 0.58 ) . There were also no significant differences in ventilation hours , ICU or hospital length of stay , or mortality . Conclusions : Perioperative alkalinization of blood and urine using an infusion of sodium b 
    Output:
    
Based on current literature , intravenous sodium bicarbonate does not seem to be more efficient than saline for the prevention of contrast-media-induced AKI , cardiac surgery-associated AKI , pigment nephropathy or septic AKI .
However , some cohort studies or prospect i ve r and omized trials did track and report serious adverse events , such as higher rates of AKI or higher in-hospital mortality .