title: Chloride-liberal fluids are associated with acute kidney injury after liver transplantation.
abstract: BACKGROUND
  Acute kidney injury (AKI) occurs frequently after liver transplantation and is associated with significant morbidity and mortality. Recent evidence has linked the predominant usage of 'chloride-liberal' intravenous fluids, such as 0.9% saline to the development of renal dysfunction in general critically ill patients. We compared the effects of perioperative fluid types on AKI in liver transplant recipients.
  
  
  METHODS
  An observational analysis of liver transplant recipients over a 33-month period, between January 2010 and September 2013, was performed. Intensive care unit database and patient records were analyzed for determinants of early postoperative AKI. Univariate and multivariate regression analysis was carried out using a two-tailed P value less than 0.05 to establish significance. The institutional Research Ethics Committee approved the study methodology (RAC no. 2131 073).
  
  
  RESULTS
  One hundred and fifty-eight liver transplants were performed, AKI developed in 57 (36.1%) patients: 39 (68.4%) fully recovered, 13 (22.8%) developed chronic renal failure and 10 (17.5%) required long-term hemodialysis. On univariate regression analysis, AKI was significantly associated with greater than 3,200 ml of chloride-liberal fluids infused within the first postoperative day (HR 5.9, 95% CI 2.64, 13.2, P < 0.001), greater than 1,500 ml colloids received in the operating room (hazard ratio (HR) 1.97, 95% CI 1.01, 3.8, P = 0.046), vasopressor requirement for 48 hours posttransplant (HR 3.34, 95% CI 1.55, 7.21, P = 0.002), hyperchloremia at day 2 (HR 1.09, 95% CI 1.01, 1.18, P = 0.015) and preoperative model for end-stage liver disease (MELD) score (HR 1.08, 95% CI 1.03, 1.13, P < 0.001). After stepwise multivariate regression, infusion of greater than 3,200 ml of chloride-liberal fluids (HR 6.25, 95% CI 2.69, 14.5, P < 0.000) and preoperative MELD score (HR 1.08, 95% CI 1.02, 1.15, P = 0.004) remained significant predictors for AKI.
  
  
  CONCLUSIONS
  In a sample of liver transplant recipients, infusion of higher volumes of chloride-liberal fluids and preoperative status was associated with an increased risk for postoperative AKI.
authors.affiliation: Department of Adult Critical Care Medicine, King Faisal Specialist Hospital and Research Centre, At Takhassusi, Al Madhar Ash Shamali, Riyadh, 12713, Saudi Arabia. ashmohnad@hotmail.com.
authors.forename: Ashraf
authors.initials: A
authors.lastname: Nadeem
authors.affiliation: Department of Adult Critical Care Medicine, King Faisal Specialist Hospital and Research Centre, At Takhassusi, Al Madhar Ash Shamali, Riyadh, 12713, Saudi Arabia. salahuddin.nawal@gmail.com.
authors.forename: Nawal
authors.initials: N
authors.lastname: Salahuddin
authors.affiliation: Department of Nursing Services, King Faisal Specialist Hospital and Research Centre, At Takhassusi, Al Madhar Ash Shamali, Riyadh, 12713, Saudi Arabia. a.m.haz@live.com.
authors.forename: Alyaa
authors.initials: A
authors.lastname: El Hazmi
authors.affiliation: Department of Adult Critical Care Medicine, King Faisal Specialist Hospital and Research Centre, At Takhassusi, Al Madhar Ash Shamali, Riyadh, 12713, Saudi Arabia. mjoseph@kfshrc.edu.sa.
authors.forename: Mini
authors.initials: M
authors.lastname: Joseph
authors.affiliation: Department of Adult Critical Care Medicine, King Faisal Specialist Hospital and Research Centre, At Takhassusi, Al Madhar Ash Shamali, Riyadh, 12713, Saudi Arabia. bbohlega@kfshrc.edu.sa.
authors.forename: Balsam
authors.initials: B
authors.lastname: Bohlega
authors.affiliation: Organ transplant Centre, King Faisal Specialist Hospital and Research Centre, At Takhassusi, Al Madhar Ash Shamali, Riyadh, 12713, Saudi Arabia. sallam-h@hotmail.com.
authors.forename: Hend
authors.initials: H
authors.lastname: Sallam
authors.affiliation: Organ transplant Centre, King Faisal Specialist Hospital and Research Centre, At Takhassusi, Al Madhar Ash Shamali, Riyadh, 12713, Saudi Arabia. yelsheikh@kfshrc.edu.sa.
authors.forename: Yasser
authors.initials: Y
authors.lastname: Sheikh
authors.affiliation: Organ transplant Centre, King Faisal Specialist Hospital and Research Centre, At Takhassusi, Al Madhar Ash Shamali, Riyadh, 12713, Saudi Arabia. dbroering@kfshrc.edu.sa.
authors.forename: Dieter
authors.initials: D
authors.lastname: Broering
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000175:diagnosis* / Q000209:etiology; D000328:Adult; D000368:Aged; D002712:Chlorides / Q000009:adverse effects*; D005260:Female; D005440:Fluid Therapy / Q000009:adverse effects*; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects* / Q000639:trends; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012965:Sodium Chloride / Q000009:adverse effects
chemical_list: D002712:Chlorides; D012965:Sodium Chloride