Higher serum chloride concentrations are associated with acute kidney injury in unselected critically ill patients

BMC Nephrology

Hongsheng Deng¹  Danyu Li¹  Haozhe Fan¹  Xiao Xu¹  Zhongheng Zhang¹ 

[1] Department of Critical Care Medicine, Jinhua Municipal Central Hospital, Jinhua Hospital of Zhejiang University, 351#, Mingyue Road, 321000 Jinhua, Zhejiang Province, China

关键词: Critically ill;    Intensive care unit;    Chloride;    Acute kidney injury;   

Others  :  1082804
DOI  :  10.1186/1471-2369-14-235

 received in 2013-07-18, accepted in 2013-10-09,  发布年份 2013

【 摘 要 】

Background

Chloride administration has been found to be harmful to the kidney in critically ill patients. However the association between plasma chloride concentration and renal function has never been investigated.

Methods

This was a retrospective study conducted in a tertiary 24-bed intensive care unit from September 2010 to November 2012. Data on serum chloride for each patient during their ICU stay were abstracted from electronic database. Cl₀ referred to the initial chloride on ICU entry, Cl_max, Cl_min and Cl_mean referred to the maximum, minimum and mean chloride values before the onset of AKI, respectively. AKI was defined according to the conventional AKIN criteria. Univariate and multivariable analysis were performed to examine the association of chloride and AKI development.

Results

A total of 1221 patients were included into analysis during study period. Three hundred and fifty-seven patients (29.2%) developed AKI. Cl_max was significantly higher in AKI than in non-AKI group (111.8 ± 8.1 vs 107.9 ±5.4 mmol/l; p < 0.001); Cl₀ was not significantly different between AKI and non-AKI patients; Cl_mean was significantly higher in AKI than non-AKI (104.3 ±5.8 vs 103.4 ± 4.5; p = 0.0047) patients. Cl_max remained to be associated with AKI in multivariable analysis (OR: 1.10, 95% CI: 1.08-1.13).

Conclusion

Chloride overload as represented by Cl_mean and Cl_max is significantly associated with the development of AKI.

【 授权许可】

   
2013 Zhang et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Chertow GM, Burdick E, Honour M, Bonventre JV, Bates DW: Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. J Am Soc Nephrol 2005, 16(11):3365-3370.
• [2]Levy EM, Viscoli CM, Horwitz RI: The effect of acute renal failure on mortality: a cohort analysis. JAMA 1996, 275(19):1489-1494.
• [3]Garcia S, Ko B, Adabag S: Contrast-induced nephropathy and risk of acute kidney injury and mortality after cardiac operations. Ann Thorac Surg 2012, 94(3):772-776.
• [4]Lassnigg A, Schmidlin D, Mouhieddine M, Bachmann LM, Druml W, Bauer P, Hiesmayr M: Minimal changes of serum creatinine predict prognosis in patients after cardiothoracic surgery: a prospective cohort study. J Am Soc Nephrol 2004, 15(6):1597-1605.
• [5]Uchino S, Bellomo R, Goldsmith D, Bates S, Ronco C: An assessment of the RIFLE criteria for acute renal failure in hospitalized patients. Crit Care Med 2006, 34(7):1913-1917.
• [6]Vincent JL: Relevance of albumin in modern critical care medicine. Best Pract Res Clin Anaesthesiol 2009, 23(2):183-191.
• [7]Wiedermann CJ: Systematic review of randomized clinical trials on the use of hydroxyethyl starch for fluid management in sepsis. BMC Emerg Med 2008, 8:1. BioMed Central Full Text
• [8]Friedrich JO, Adhikari N, Herridge MS, Beyene J: Meta-analysis: low-dose dopamine increases urine output but does not prevent renal dysfunction or death. Ann Intern Med 2005, 142(7):510-524.
• [9]Cogliati AA, Vellutini R, Nardini A, Urovi S, Hamdan M, Landoni G, Guelfi P: Fenoldopam infusion for renal protection in high-risk cardiac surgery patients: a randomized clinical study. J Cardiothorac Vasc Anesth 2007, 21(6):847-850.
• [10]Valsson F, Ricksten SE, Hedner T, Zäll S, William-Olsson EB, Lundin S: Effects of atrial natriuretic peptide on renal function after cardiac surgery and in cyclosporine-treated heart transplant recipients. J Cardiothorac Vasc Anesth 1994, 8(4):425-430.
• [11]Wilcox CS: Regulation of renal blood flow by plasma chloride. J Clin Invest 1983, 71(3):726-735.
• [12]Wilcox CS: Renal haemodynamics during hyperchloraemia in the anaesthetized dog: effects of captopril. J Physiol 1988, 406:27-34.
• [13]Yunos NM, Bellomo R, Hegarty C, Story D, Ho L, Bailey M: Association between a chloride-liberal vs chloride-restrictive intravenous fluid administration strategy and kidney injury in critically ill adults. JAMA 2012, 308(15):1566-1572.
• [14]Cıldır E, Bulut M, Akalın H, Kocabaş E, Ocakoğlu G, Aydın SA: Evaluation of the modified MEDS, MEWS score and Charlson comorbidity index in patients with community acquired sepsis in the emergency department. Intern Emerg Med 2013, 8:255-60.
• [15]Christensen S, Johansen MB, Christiansen CF, Jensen R, Lemeshow S: Comparison of Charlson comorbidity index with SAPS and APACHE scores for prediction of mortality following intensive care. Clin Epidemiol 2011, 3:203-211.
• [16]Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group: KDIGO clinical practice guideline for acute kidney injury. Kidney inter 2012, 2(Suppl):1-138.
• [17]Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P: Acute dialysis quality initiative workgroup: acute renal failure-definition, outcome measures, animal models, fluid therapy and information technology needs: the second international consensus conference of the acute dialysis quality initiative (ADQI) group. Crit Care 2004, 8(4):R204-R212. BioMed Central Full Text
• [18]National Kidney Foundation: K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 2002, 39(2 Suppl 1):S1-S266.
• [19]Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, Levin A, Acute Kidney Injury Network: Acute kidney injury network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 2007, 11(2):R31. BioMed Central Full Text
• [20]Wu BU, Hwang JQ, Gardner TH, Repas K, Delee R, Yu S, Smith B, Banks PA, Conwell DL: Lactated Ringer’s solution reduces systemic inflammation compared with saline in patients with acute pancreatitis. Clin Gastroenterol Hepatol 2011, 9(8):710-717.
• [21]Yegenaga I, Tuglular S, Ari E, Etiler N, Baykara N, Torlak S, Acar S, Akbas T, Toker K, Solak ZM: Evaluation of sepsis/systemic inflammatory response syndrome, acute kidney injury, and RIFLE criteria in two tertiary hospital intensive care units in Turkey. Nephron Clin Pract 2010, 115(4):c276-c282.
• [22]Takahashi K, Mizukami H, Kamata K, Inaba W, Kato N, Hibi C, Yagihashi S: Amelioration of acute kidney injury in lipopolysaccharide-induced systemic inflammatory response syndrome by an aldose reductase inhibitor, fidarestat. PLoS One 2012, 7(1):e30134.
• [23]Cartin-Ceba R, Kashiouris M, Plataki M, Kor DJ, Gajic O, Casey ET: Risk factors for development of acute kidney injury in critically ill patients: a systematic review and meta-analysis of observational studies. Crit Care Res Pract 2012. doi:10.1155/2012/691013
• [24]Chowdhury AH, Cox EF, Francis ST, Lobo DNA: A randomized, controlled, double-blind crossover study on the effects of 2-L infusions of 0.9% saline and plasma-lyte® 148 on renal blood flow velocity and renal cortical tissue perfusion in healthy volunteers. Ann Surg 2012, 256(1):18-24.
• [25]Klima T, Christ A, Marana I, Kalbermatter S, Uthoff H, Burri E, Hartwiger S, Schindler C, Breidthardt T, Marenzi G, Mueller C: Sodium chloride vs. sodium bicarbonate for the prevention of contrast medium-induced nephropathy: a randomized controlled trial. Eur Heart J 2012, 33(16):2071-2079.
• [26]Zoungas S, Ninomiya T, Huxley R, Cass A, Jardine M, Gallagher M, Patel A, Vasheghani-Farahani A, Sadigh G, Perkovic V: Systematic review: sodium bicarbonate treatment regimens for the prevention of contrast-induced nephropathy. Ann Intern Med 2009, 151(9):631-638.
• [27]Adolph E, Holdt-Lehmann B, Chatterjee T, Paschka S, Prott A, Schneider H, Koerber T, Ince H, Steiner M, Schuff-Werner P, Nienaber CA: Renal insufficiency following radiocontrast exposure trial (REINFORCE): a randomized comparison of sodium bicarbonate versus sodium chloride hydration for the prevention of contrast-induced nephropathy. Coron Artery Dis 2008, 19(6):413-419.
• [28]Brar SS, Shen AY, Jorgensen MB, Kotlewski A, Aharonian VJ, Desai N, Ree M, Shah AI, Burchette RJ: Sodium bicarbonate vs sodium chloride for the prevention of contrast medium-induced nephropathy in patients undergoing coronary angiography: a randomized trial. JAMA 2008, 300(9):1038-1046.
• [29]Maioli M, Toso A, Leoncini M, Gallopin M, Tedeschi D, Micheletti C, Bellandi F: Sodium bicarbonate versus saline for the prevention of contrast-induced nephropathy in patients with renal dysfunction undergoing coronary angiography or intervention. J Am Coll Cardiol 2008, 52(8):599-604.
• [30]Zhang Z, Ni C: C-reactive protein as a predictor of mortality in critically ill patients: a meta-analysis and systematic review. Anaesth Intensive Care 2011, 39(5):854-861.
• [31]Zhang Z, Zhang Z, Xue Y, Xu X, Ni H: Prognostic value of B-type natriuretic peptide (BNP) and its potential role in guiding fluid therapy in critically ill septic patients. Scand J Trauma Resusc Emerg Med 2012, 20:86. BioMed Central Full Text
• [32]Zhang Z, Lu B, Sheng X, Jin N: Cystatin C in prediction of acute kidney injury: a systemic review and meta-analysis. Am J Kidney Dis 2011, 58(3):356-365.
• [33]Valette X, Savary B, Nowoczyn M, Daubin C, Pottier V, Terzi N, Seguin A, Fradin S, Charbonneau P, Hanouz JL, Du Cheyron D: Accuracy of plasma neutrophil gelatinase-associated lipocalin in the early diagnosis of contrast-induced acute kidney injury in critical illness. Intensive Care Med 2013, 39(5):857-65.
• [34]Allison SJ: Acute kidney injury: restriction of intravenous chloride intake may reduce the incidence of AKI in critically ill patients. Nat Rev Nephrol 2012, 8(12):679.