title: Dyschloremia Is a Risk Factor for the Development of Acute Kidney Injury in Critically Ill Patients.
abstract: BACKGROUND
  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.
  
  
  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).
  
  
  CONCLUSIONS
  Dyschloremia is common in critically ill patients, and severe hypochloremia is independently associated with an increased risk of development of acute kidney injury.
authors.affiliation: Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, United States of America.|Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC) Research Group, Mayo Clinic, Rochester, MN, United States of America.|Department of Critical Care Medicine, Anhui Provincial hospital Affiliated to Anhui Medical University, Hefei, Anhui, China.
authors.forename: Min
authors.initials: M
authors.lastname: Shao
authors.affiliation: Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC) Research Group, Mayo Clinic, Rochester, MN, United States of America.|Department of Pulmonary Medicine, Guang'Anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
authors.forename: Guangxi
authors.initials: G
authors.lastname: Li
authors.affiliation: Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, United States of America.|Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC) Research Group, Mayo Clinic, Rochester, MN, United States of America.
authors.forename: Kumar
authors.initials: K
authors.lastname: Sarvottam
authors.affiliation: Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC) Research Group, Mayo Clinic, Rochester, MN, United States of America.|Department of Pulmonary Medicine, The First Affiliated Hospital of Xi'an Medical University, Shaanxi, China.
authors.forename: Shengyu
authors.initials: S
authors.lastname: Wang
authors.affiliation: Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC) Research Group, Mayo Clinic, Rochester, MN, United States of America.
authors.forename: Charat
authors.initials: C
authors.lastname: Thongprayoon
authors.affiliation: Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC) Research Group, Mayo Clinic, Rochester, MN, United States of America.
authors.forename: Yue
authors.initials: Y
authors.lastname: Dong
authors.affiliation: Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC) Research Group, Mayo Clinic, Rochester, MN, United States of America.|Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, United States of America.
authors.forename: Ognjen
authors.initials: O
authors.lastname: Gajic
authors.affiliation: Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, United States of America.|Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC) Research Group, Mayo Clinic, Rochester, MN, United States of America.|Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, United States of America.
authors.forename: Kianoush
authors.identifier: http://orcid.org/0000-0003-2184-3683
authors.initials: K
authors.lastname: Kashani
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood*; D000328:Adult; D000368:Aged; D002712:Chlorides / Q000097:blood*; D016638:Critical Illness; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D002712:Chlorides