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. 2025 Dec;47(1):2536731.
doi: 10.1080/0886022X.2025.2536731. Epub 2025 Jul 23.

Initial serum chloride is associated with all-cause mortality in critically ill patients with acute kidney injury

Dezhun Chen  1 , Fengfeng Lu  1 , Bihuan Cheng  1 , Benji Wang  1
Affiliations

Initial serum chloride is associated with all-cause mortality in critically ill patients with acute kidney injury

Dezhun Chen et al. Ren Fail. 2025 Dec.

Abstract

Objective: Disorders related to serum chloride concentration have recently attracted considerable interest. We sought to determine whether initial serum chloride was associated with an increased risk of all-cause mortality among critically ill patients diagnosed with acute kidney injury (AKI).

Methods: We searched the Multiparameter Intelligent Monitoring in the Intensive Care IV database to retrieve clinical data, including demographic factors, clinical variables, lab tests, and scoring systems. Hypothesis testing was conducted using a range of statistical approaches, including the generalized additive model, the Cox proportional hazards model, and subgroup analyses.

Results: Our research included 19,107 participants who met the set criteria. We found that the levels of chloride in the patient's serum upon admission had a similar inverted L-shaped relationship with the 30-day all-cause mortality rate in AKI. In multivariate analysis following the adjustment of confounders such as sex, ethnicity, and age, compared with the referent group (100-105 mmol/L), low-chloride (< 100 mmol/L) was a considerable risk predictor for 30-day, 90-day, and 365-day all-cause mortality. In particular, the HRs (95% CIs) for chloride were 1.49 (1.36, 1.63), 1.48 (1.36, 1.61), and 1.59 (1.47, 1.71). After adjusting additional clinical characteristics, low-chloride levels still served independently as a major predictor of all-cause mortality over 30 days, 90 days, and 365 days (HR, 95% CI: 1.24, 1.09-1.41; 1.17, 1.04-1.32; 1.27, 1.14-1.42).

Conclusions: The probability of all-cause mortality was higher in severely ill individuals with AKI who had lower baseline serum chloride levels upon admission to the intensive care unit (ICU).

Keywords: Acute kidney injury; Serum chloride; biomarker; mortality.

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Conflict of interest statement

No potential conflict of interest was reported by the author(s).

Figures

Figure 1.
Figure 1.
The relationship between chloride and 30-day all-cause mortality among critically ill patients with AKI.
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