Effect of hyperchloremia on acute kidney injury in critically ill septic patients: a retrospective cohort study

Abstract

BackgroundHyperchloremia is common in critically ill septic patients. The impact of hyperchloremia on the incidence of acute kidney injury (AKI) is not well studied. We investigated the association between hyperchloremia and AKI within the first 72 h of intensive care unit (ICU) admission.Methods6490 ICU adult patients admitted with severe sepsis or septic shock were screened for eligibility. Exclusion criteria included: AKI on admission, baseline estimated glomerular filtration rate (eGFR) <15 ml/min/1.73 m2, chronic renal replacement therapy, absent baseline serum creatinine data, and absent serum chloride data on ICU admission.ResultsA total of 1045 patients were available for analysis following the implementation of eligibility criteria: 303 (29%) had hyperchloremia (Cl0 ≥ 110 mEq/L) on ICU admission, 561 (54%) were normochloremic (Cl0 101–109 mEq/L) and 181 (17%) were hypochloremic (Cl0 ≤ 100 mEq/L). AKI within the first 72 h of ICU stay was the dependent variable. Chloride on ICU admission (Cl0) and change in Cl by 72 h (ΔCl = Cl72 – Cl0) were the independent variables. The odds for AKI were not different in the hyperchloremic group when compared to the normochloremic group [adjusted odds ratio (OR) =0.80, 95% confidence interval [CI] (0.51–1.25); p = 0.33] after adjusting for demographics, comorbidities, baseline kidney function, drug exposure and critical illness indicators including cumulative fluid balance and base deficit. Furthermore, within the subgroup of patients with hyperchloremia on ICU admission, neither Cl0 nor ΔCl was associated with AKI or with moderate/severe AKI (KDIGO Stage ≥2).ConclusionsHyperchloremia occurs commonly among critically ill septic patients admitted to the ICU, but does not appear to be associated with an increased risk for AKI within the first 72 h of admission.

Hyperchloremia and postoperative acute kidney injury: a retrospective analysis of data from the surgical intensive care unit

“…In this retrospective review of 7991 patients, we found that exposure to hyperchloremia was not an independent risk factor for postoperative AKI in patients admitted to the ICU after surgery. This result is consistent with the findings of Yessayan et al [ 15 ], who also observed no significant association between hyperchloremia and AKI within 72 h of ICU admission in patients with sepsis or septic shock. However, while Yessayan et al excluded patients with CKD stage 5 [ 15 ], we did not exclude such patients from our analysis.…”

“…This result is consistent with the findings of Yessayan et al [ 15 ], who also observed no significant association between hyperchloremia and AKI within 72 h of ICU admission in patients with sepsis or septic shock. However, while Yessayan et al excluded patients with CKD stage 5 [ 15 ], we did not exclude such patients from our analysis. However, we excluded 195 patients who died within 72 h after surgery, whereas Yessayan et al included such patients.…”

“…Our reason for excluding patients who died within 72 h was that such patients might have AKI associated with another critical illness not related to perioperative hyperchloremia, such as multi-organ failure or massive bleeding. Yessayan et al also noted that AKI was not associated with an increase in Cl − [ 15 ]. However, in the present study, we found that patients with CKD stage ≥ 3 who exhibit a Cl − increase > 6 mmol·L − 1 during PODs 0–3 have higher risk of postoperative AKI.…”

“…However, since Cl − is routinely measured preoperatively in most tertiary care hospitals in South Korea, we could perform a detailed analysis of the influence of Cl − levels on AKI incidence. Other studies have also identified the increase in Cl − as an important factor for occurrence of AKI [ 8 , 15 , 19 ].…”

Acid base variables predict survival early in the course of treatment with continuous venovenous hemodiafiltration

“…The finding that hyperchloremic acidosis was associated with worse outcome is also notable because this form of acidosis is not clearly as hazardous from a clinical perspective [ 20 ] although animal studies have shown deleterious effect of hyperchloremia in experimental sepsis [ 21 , 22 ] and in agreement of this recent studies in human reported similar findings. [ 18 , 23 – 25 ]…”