title: The relationship of intravenous fluid chloride content to kidney function in patients with severe sepsis or septic shock.
abstract: BACKGROUND
  Previous studies suggest a relationship between chloride-rich intravenous fluids and acute kidney injury in critically ill patients.
  
  
  OBJECTIVE
  The aim of this study was to evaluate the relationship of intravenous fluid chloride content to kidney function in patients with severe sepsis or septic shock.
  
  
  METHODS
  A retrospective chart review was performed to determine (1) quantity and type of bolus intravenous fluids, (2) serum creatinine (Cr) at presentation and upon discharge, and (3) need for emergent hemodialysis (HD) or renal replacement therapy (RRT). Linear regression was used for continuous outcomes, and logistic regression was used for binary outcomes and results were controlled for initial Cr. The primary outcome was change in Cr from admission to discharge. Secondary outcomes were need for HD/RRT, length of stay (LOS), mortality, and organ dysfunction.
  
  
  RESULTS
  There were 95 patients included in the final analysis; 48% (46) of patients presented with acute kidney injury, 8% (8) required first-time HD or RRT, 61% (58) were culture positive, 55% (52) were in shock, and overall mortality was 20% (19). There was no significant relationship between quantity of chloride administered in the first 24 hours with change in Cr (β = -0.0001, t = -0.86, R(2) = 0.92, P = .39), need for HD or RRT (odds ratio [OR] = 0.999; 95% confidence interval [CI], 0.999-1.000; P = .77), LOS >14 days (OR = 1.000; 95% CI, 0.999-1.000; P = .68), mortality (OR = 0.999; 95% CI, 0.999-1.000; P = .88), or any type of organ dysfunction.
  
  
  CONCLUSIONS
  Chloride administered in the first 24 hours did not influence kidney function in this cohort with severe sepsis or septic shock.
authors: University of Florida College of Medicine, Jacksonville, Department of Emergency Medicine, Jacksonville, FL. Electronic address: Faheem.Guirgis@jax.ufl.edu.
authors: Faheem W
authors: FW
authors: Guirgis
authors: University of Florida College of Medicine, Jacksonville, Department of Emergency Medicine, Jacksonville, FL.
authors: Deborah J
authors: DJ
authors: Williams
authors: University of Florida College of Medicine, Jacksonville, Department of Emergency Medicine, Jacksonville, FL.
authors: Matthew
authors: M
authors: Hale
authors: University of Florida College of Medicine, Jacksonville, Division of Pulmonary/Critical Care Medicine.
authors: Abubakr A
authors: AA
authors: Bajwa
authors: University of Florida College of Medicine, Jacksonville, Division of Pulmonary/Critical Care Medicine.
authors: Adil
authors: A
authors: Shujaat
authors: University of Florida College of Medicine, Jacksonville, Department of Emergency Medicine, Jacksonville, FL.
authors: Nisha
authors: N
authors: Patel
authors: University of Florida College of Medicine, Jacksonville, Department of Emergency Medicine, Jacksonville, FL.
authors: Colleen J
authors: CJ
authors: Kalynych
authors: University of Mississippi Medical Center, Department of Emergency Medicine, Jackson, MS.
authors: Alan E
authors: AE
authors: Jones
authors: University of Florida College of Medicine, Jacksonville, Department of Emergency Medicine, Jacksonville, FL.
authors: Robert L
authors: RL
authors: Wears
authors: University of Florida College of Medicine, Jacksonville, Division of Cardiology, Department of Internal Medicine.
authors: Sunita
authors: S
authors: Dodani
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000139:chemically induced* / Q000628:therapy; D000368:Aged; D002712:Chlorides / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood; D005260:Female; D005440:Fluid Therapy / Q000009:adverse effects*; D006801:Humans; D007902:Length of Stay; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D017582:Renal Replacement Therapy / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018805:Sepsis / Q000150:complications / Q000628:therapy; D012772:Shock, Septic / Q000150:complications / Q000628:therapy*; D012965:Sodium Chloride / Q000009:adverse effects / Q000737:chemistry; D014883:Water-Electrolyte Imbalance / Q000209:etiology / Q000628:therapy*
chemical_list: D002712:Chlorides; D012965:Sodium Chloride; D003404:Creatinine