title: Hyperchloremia and moderate increase in serum chloride are associated with acute kidney injury in severe sepsis and septic shock patients.
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-]maxwas 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.
authors.affiliation: Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, 1081 Burrard Street., Vancouver, BC, V6Z 1Y6, Canada.|Department of Pediatrics, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand.
authors.forename: Bandarn
authors.initials: B
authors.lastname: Suetrong
authors.affiliation: Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, 1081 Burrard Street., Vancouver, BC, V6Z 1Y6, Canada.|Department of Anesthesiology, Ramathibodi Hospital, Faculty of Medicine, Mahidol University, Bangkok, Thailand.
authors.forename: Chawika
authors.initials: C
authors.lastname: Pisitsak
authors.affiliation: Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, 1081 Burrard Street., Vancouver, BC, V6Z 1Y6, Canada.
authors.forename: John H
authors.initials: JH
authors.lastname: Boyd
authors.affiliation: Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, 1081 Burrard Street., Vancouver, BC, V6Z 1Y6, Canada.
authors.forename: James A
authors.initials: JA
authors.lastname: Russell
authors.affiliation: Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, 1081 Burrard Street., Vancouver, BC, V6Z 1Y6, Canada. Keith.Walley@hli.ubc.ca.
authors.forename: Keith R
authors.initials: KR
authors.lastname: Walley
mesh_terms: D018806:APACHE; D058186:Acute Kidney Injury / Q000453:epidemiology / Q000503:physiopathology*; D000328:Adult; D000368:Aged; D001955:British Columbia / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D006339:Heart Rate; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units / Q000458:organization & administration / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012044:Regression Analysis; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018805:Sepsis / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology; D012772:Shock, Septic / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology; D012965:Sodium Chloride / Q000032:analysis* / Q000097:blood; D014662:Vasoconstrictor Agents / Q000627:therapeutic use; D014883:Water-Electrolyte Imbalance
chemical_list: D014662:Vasoconstrictor Agents; D012965:Sodium Chloride
keywords: Acute kidney injury; Chloride; Hyperchloremia; Sepsis; Septic shock