Dyschloremia Is a Risk Factor for the Development of Acute Kidney Injury in Critically Ill Patients

Shao, Min; Li, Guangxi; Sarvottam, Kumar; Wang, Shengyu; Dong, Yue; Gajic, Ognjen; Kashani, Kianoush

doi:10.1371/journal.pone.0160322

Cited by 45 publications

(58 citation statements)

References 27 publications

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“…A recent meta-analysis of 21 studies (6,253 patients) found that administration of chloride-rich fluids was associated with increased risk for hyperchloremic acidosis and AKI but not mortality (3). Most recently, in a retrospective cohort study, Shao et al reported a positive association between serum chloride level and AKI (9). Interesting, in this study severe hypochloremia was also associated with increased AKI risk.…”

supporting

confidence: 57%

Has the time come to abandon chloride-rich resuscitation fluids?

Heung¹,

Yessayan²

2017

Ann. Transl. Med.

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supporting

confidence: 57%

Has the time come to abandon chloride-rich resuscitation fluids?

Heung¹,

Yessayan²

2017

Ann. Transl. Med.

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“…In recent years, there have been several reports regarding novel and previously unknown risk factors for AKI, such as hyperuricemia 19 , hypoalbuminemia 20 , obesity 21 , obstructive sleep apnea 22 , hypochloremia and hyperchloremia 23 . In our study, BMI and obesity (COM2) were both selected in the top ten by several FS methods as shown in Table 4.…”

Section: Resultsmentioning

confidence: 99%

Feature Ranking in Predictive Models for Hospital-Acquired Acute Kidney Injury

Liu

et al. 2018

Sci Rep

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Acute Kidney Injury (AKI) is a common complication encountered among hospitalized patients, imposing significantly increased cost, morbidity, and mortality. Early prediction of AKI has profound clinical implications because currently no treatment exists for AKI once it develops. Feature selection (FS) is an essential process for building accurate and interpretable prediction models, but to our best knowledge no study has investigated the robustness and applicability of such selection process for AKI. In this study, we compared eight widely-applied FS methods for AKI prediction using nine-years of electronic medical records (EMR) and examined heterogeneity in feature rankings produced by the methods. FS methods were compared in terms of stability with respect to data sampling variation, similarity between selection results, and AKI prediction performance. Prediction accuracy did not intrinsically guarantee the feature ranking stability. Across different FS methods, the prediction performance did not change significantly, while the importance rankings of features were quite different. A positive correlation was observed between the complexity of suitable FS method and sample size. This study provides several practical implications, including recognizing the importance of feature stability as it is desirable for model reproducibility, identifying important AKI risk factors for further investigation, and facilitating early prediction of AKI.

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“…Already, Story et al showed that hyperchloremic acidosis was a type of SID a acidosis [13,14]. Therefore, if Tani et al had de ned their groups in accordance with SID a values instead of only Cl levels, they would not have made the mistake that they did, with the mean SID a value of their normochloremia group as low as 33.9±3.5 [6,7]. Hence, we think that using accepted Cl limits to de ne hyperchloremic acidosis or hypochloremic alkalosis is not adequate.…”

Section: De Nitions Of Hyperchloremic Acidosis and Hypochloremic Alkamentioning

confidence: 99%

“…It had the weakest correlations and Cl obs was not associated with the SBE (Tables 1, 3 and 4). We believe that the reason for incompatible results in some chloride studies may be the use of the accepted Cl limits [6,7,15].…”

Section: De Nitions Of Hyperchloremic Acidosis and Hypochloremic Alkamentioning

confidence: 99%

“…However, each of these approaches has different fundamental concepts. Moreover, different normal limits for observed Cl (Cl obs ) can be accepted, such as 98-106 mmol/L, 100-108 mmol/L and 95-110 mmol/L [6][7][8]. On the other hand, for the same patient, Cl corrections, the Cl/Na ratio and BE Cl can yield different effects of Cl on the acid-base status at the same time.…”

Section: Introductionmentioning

confidence: 99%

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Base-excess chloride; the best approach to evaluating the effect of chloride on the acid- base status: a retrospective study

Güçyetmez

Tüzüner

Atalan³

et al. 2020

Preprint

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Background: To determine the effect of chloride on the acid-base status, four approaches are currently used: 1) accepted ranges of serum chloride values; 2) chloride corrections, such as chloride deficiency/excess and chloride modification; 3) the Cl/Na ratio; and 4) the sodium- chloride difference, such as base-excess chloride. However, these approaches are governed by different concepts, and they can evaluate the effects of chloride on the acid-base status differently. Our aim is to investigate which approach to the evaluation of the effect of chloride is the best.Methods: In this retrospective cohort study, 2529 critically ill patients who were admitted to the tertiary care unit were evaluated between 2011 and 2018. Patient characteristics and blood gas parameters at the ICU admission and outcomes were recorded. The effects of chloride on the acid-base status according to each evaluative approach were validated by the standard base excess and apparent strong ion difference. To compare approaches, kappa and Bland-Altman tests and a linear regression model were used. Results: In the linear regression model for all patients, only base-excess chloride in all the chloride evaluation approaches was significantly related to the standard base excess. In the subgroup, the correlation and limits of agreement between base-excess chloride and the standard base excess were the strongest (r2=0.92 p<0.001 bias: 0.5mmol/L). Conclusions: For the evaluation of the effect of chloride on the acid-base status, base-excess chloride is a better approach than accepted ranges of serum chloride values, chloride corrections and the Cl/Na ratio.

show abstract

Dyschloremia Is a Risk Factor for the Development of Acute Kidney Injury in Critically Ill Patients

Cited by 45 publications

References 27 publications

Has the time come to abandon chloride-rich resuscitation fluids?

Has the time come to abandon chloride-rich resuscitation fluids?

Feature Ranking in Predictive Models for Hospital-Acquired Acute Kidney Injury

Base-excess chloride; the best approach to evaluating the effect of chloride on the acid- base status: a retrospective study

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