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

Abstract

Introduction: Dyschloremia is common in critically ill patients, although its impact has not been well studied. We investigated the epidemiology of dyschloremia and its associations with the incidence of acute kidney injury and other intensive care unit outcomes.

Material and methods: This is a single-center, retrospective cohort study at Mayo Clinic Hospital-Rochester. All adult patients admitted to intensive care units from January 1st, 2006, through December 30th, 2012 were included. Patients with known acute kidney injury and chronic kidney disease stage 5 before intensive care unit admission were excluded. We evaluated the association of dyschloremia with ICU outcomes, after adjustments for the effect of age, gender, Charlson comorbidity index and severity of illness score.

Results: A total of 6,025 patients were enrolled in the final analysis following the implementation of eligibility criteria. From the cohort, 1,970 patients (33%) developed acute kidney injury. Of the total patients enrolled, 4,174 had a baseline serum chloride. In this group, 1,530 (37%) had hypochloremia, and 257 (6%) were hyperchloremic. The incidence of acute kidney injury was higher in hypochloremic and hyperchloremic patients compared to those with a normal serum chloride level (43% vs.30% and 34% vs. 30%, respectively; P < .001). Baseline serum chloride was lower in the acute kidney injury group vs. the non-acute kidney injury group [100 mmol/L (96-104) vs. 102 mmol/L (98-105), P < .0001]. In a multivariable logistic regression model, baseline serum chloride of ≤94 mmol/L found to be independently associated with the risk of acute kidney injury (OR 1.7, 95% CI 1.1-2.6; P = .01).

Discussion: Dyschloremia is common in critically ill patients, and severe hypochloremia is independently associated with an increased risk of development of acute kidney injury.

Fig 1. Study design and a flowchart of the recruitment process and the reasons for exclusion.

Abbreviations: AKI, acute kidney injury; CKD, chronic kidney disease.

Fig 2

A) Frequency of dyschloremia before and after the ICU admission; B) Incidence of AKI according to the baseline serum chloride concentrations; C) Incidence of AKI stages according to the baseline serum chloride concentrations; D) Hospital and intensive care unit (ICU) mortality according to different baseline serum chloride concentrations; E) Hospital and ICU length of stay (LOS) according to different baseline serum chloride concentrations.