Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Oct 6;20(1):315.
doi: 10.1186/s13054-016-1499-7.

Hyperchloremia and moderate increase in serum chloride are associated with acute kidney injury in severe sepsis and septic shock patients

Bandarn Suetrong  1   2 , Chawika Pisitsak  1   3 , John H Boyd  1 , James A Russell  1 , Keith R Walley  4
Affiliations

Hyperchloremia and moderate increase in serum chloride are associated with acute kidney injury in severe sepsis and septic shock patients

Bandarn Suetrong et al. Crit Care. .

Abstract

Background: Acute kidney injury and hyperchloremia are commonly present in critically ill septic patients. Our study goal was to evaluate the association of hyperchloremia and acute kidney injury in severe sepsis and septic shock patients.

Methods: In this retrospective cohort study in a provincial tertiary care hospital, adult patients with severe sepsis or septic shock and serum chloride measurements were included. Serum chloride was measured on a daily basis for 48 hours. Primary outcome was development of acute kidney injury (AKI) and association of AKI and serum chloride parameters was analyzed.

Results: A total of 240 patients were included in the study, 98 patients (40.8 %) had hyperchloremia. The incidence of acute kidney injury (AKI) was significantly higher in the hyperchloremia group (85.7 % vs 47.9 %; p < 0.001). Maximal chloride concentration in the first 48 hours ([Cl-]max) was significantly associated with AKI. In multivariate analysis, [Cl-]max was independently associated with AKI [adjusted odds ratio (OR) for AKI = 1.28 (1.02-1.62); p = 0.037]. The increase in serum chloride (Δ[Cl-] = [Cl-]max - initial chloride concentration) demonstrated a dose-dependent relationship with severity of AKI. The mean Δ[Cl-] in patients without AKI was 2.1 mmol/L while in the patients with AKI stage 1, 2 and 3 the mean Δ[Cl-] was 5.1, 5.9 and 6.7 mmol/L, respectively. A moderate increase in serum chloride (Δ[Cl-] ≥ 5 mmol/L) was associated with AKI [OR = 5.70 (3.00-10.82); p < 0.001], even in patients without hyperchloremia [OR = 8.25 (3.44-19.78); p < 0.001].

Conclusions: Hyperchloremia is common in severe sepsis and septic shock and independently associated with AKI. A moderate increase in serum chloride (Δ[Cl-] ≥5 mmol/L) is associated with AKI even in patients without hyperchloremia.

Keywords: Acute kidney injury; Chloride; Hyperchloremia; Sepsis; Septic shock.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Flow chart of the patients with severe sepsis and septic shock in the study. [Cl - ] max maximal chloride concentration in the first 48 hours, AKI acute kidney injury, CRF chronic renal failure
Fig. 2
Fig. 2
Increase in serum chloride and AKI severity. The mean increase in serum chloride (Δ[Cl-]) in AKI stage 1, 2 and 3 is significantly higher than in patients without AKI (p < 0.05) and these data suggest a dose-response relationship between Δ[Cl-] and AKI stage. Δ[Cl - ] increase in serum chloride, AKI acute kidney injury,
See this image and copyright information in PMC

References

    1. Poukkanen M, Vaara ST, Pettilä V, et al. Acute kidney injury in patients with severe sepsis in Finnish Intensive Care Units. Acta Anaesthesiol Scand. 2013;57:863–72. doi: 10.1111/aas.12133. - DOI - PubMed
    1. Lopes JA, Jorge S, Resina C, et al. Acute kidney injury in patients with sepsis: a contemporary analysis. Int J Infect Dis. 2009;13:176–81. doi: 10.1016/j.ijid.2008.05.1231. - DOI - PubMed
    1. Vanmassenhove J, Lameire N, Dhondt A, Vanholder R, Van Biesen W. Prognostic robustness of serum creatinine based AKI definitions in patients with sepsis: a prospective cohort study. BMC Nephrol. 2015;16:112. doi: 10.1186/s12882-015-0107-4. - DOI - PMC - PubMed
    1. Lopes JA, Fernandes P, Jorge S, et al. Long-term risk of mortality after acute kidney injury in patients with sepsis: a contemporary analysis. BMC Nephrol. 2010;11:9. doi: 10.1186/1471-2369-11-9. - DOI - PMC - PubMed
    1. Linder A, Fjell C, Levin A, Walley KR, Russell JA, Boyd JH. Small acute increases in serum creatinine are associated with decreased long-term survival in the critically ill. Am J Respir Crit Care Med. 2014;189:1075–81. doi: 10.1164/rccm.201311-2097OC. - DOI - PubMed

MeSH terms