An Association Between Hyperchloremia and Acute Kidney Injury in Patients With Acute Ischemic Stroke

Abstract

Background and Purpose: While an association between hyperchloremia and worse outcomes, such as acute kidney injury and increased mortality, has been demonstrated in hemorrhagic stroke, it is unclear whether the same relationship exists after acute ischemic stroke. This study aims to determine the relationship between moderate hyperchloremia (serum chloride ≥115 mmol/L) and acute kidney injury in patients with ischemic stroke. Methods: This is a multicenter, retrospective, propensity-matched cohort study of adults admitted for acute ischemic stroke. The primary objective was to determine the relationship between moderate hyperchloremia and acute kidney injury, as defined by the Acute Kidney Injury Network criteria. Secondary objectives included mortality and hospital length of stay. Results: A total of 407 patients were included in the unmatched cohort (332 nonhyperchloremia and 75 hyperchloremia) and 114 patients (57 in each group) were matched based upon propensity scores. In the matched cohort, hyperchloremia was associated with an increased risk of acute kidney injury (relative risk 1.91 [95% confidence interval 1.01-3.59]) and a longer hospital length of stay (16 vs 12 days; P = .03). Mortality was higher in the hyperchloremia group (19.3% vs 10.5%, P = .19), but this did not reach statistical significance. Conclusions: In this study, hyperchloremia after ischemic stroke was associated with increased rates of acute kidney injury and longer hospital length of stay. Further research is needed to determine which interventions may increase chloride levels in patients with acute ischemic stroke and the association between hyperchloremia and clinical outcomes.

Hyperchloremia and mortality in the ICU: a prospective cohort study

“…19,20 Regarding the association between hyperchloremia and mortality, the study presents a similar RR to the investigations of Aguilar (RR=1.88; CI=1.41-2.51) 17 and Medina in a cohort with characteristics similar to the of the current work, in which they found (RR=3.12; CI=95%: 2.16-4.49). 16 Regarding the association with kidney failure, the results of this study agree with those of Haller, with a RR=1.91 (CI=95%: 1.01-3.59) 15 and Medina with a RR= 1.76 with a CI=95%: 1.42-2.17. 16 Based on these results, it can be stated that chloride disturbances are associated with a higher risk of negative outcomes in critical medicine.…”

“…14 Haller et al describe an association between hyperchloremia and acute renal failure and number of hospital days, calculating a relative risk (RR) of 1.91 (95% CI: 1.01-3.59) for acute renal failure and hospital days (16 days vs 12 days, p=0.03); however, they failed to establish the association between hyperchloremia and mortality. 15 In Colombia, there is a single retrospective cohort study led by Medina et al, in which the relationship between hyperchloremia and mortality in critical patients was analyzed, finding a RR=3.12 (CI=95% 2.16-4.49) (p<0.001) for mortality and a RR =1.76 (CI=95% 1.42-2.17) (p<0.001) regarding the development of acute renal failure. 16…”

The Role Of Serum Electrolyte Level In Stroke Prognosis

“…The copyright holder for this preprint this version posted July 25, 2022. ; https://doi.org/10.1101/2022.07.24.22277969 doi: medRxiv preprint 3 months, MRS invariably had hyperchloremia, but an independent association could not be found. Some of the past studies found similar trends where hyperchloremia was associated with bad long term outcome in stroke (16) (17). Causes of hyperchloremia need to be looked further as any excessive use of intravenous infusions, presence of normal anion gap metabolic acidosis, or acute kidney injury and an attempt should be made to determine the causal relationship between hyperchloremia and poor outcome, if any (18).…”