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Association of plasma chloride values with acute kidney injury in the critically ill – a prospective observational study
Author(s) -
Marttinen M.,
Wilkman E.,
Petäjä L.,
SuojarantaYlinen R.,
Pettilä V.,
Vaara S. T.
Publication year - 2016
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/aas.12694
Subject(s) - hyperchloremia , medicine , acute kidney injury , intensive care unit , prospective cohort study , rifle , observational study , critically ill , kidney disease , anesthesia , gastroenterology , intensive care medicine , acidosis , archaeology , history
Background Chloride‐rich fluids have been found to associate with an increased risk for acute kidney injury ( AKI ) among intensive care unit ( ICU ) patients. Studies evaluating the association of plasma chloride (Cl) with the development of AKI are few. We hypothesized that higher plasma Cl is associated with an increased risk for the development of AKI . Methods In this sub‐study of the prospective FINNAKI study, we analyzed Cl values measured during ICU stay in two ICU s at a tertiary center including 445 patients. We calculated time‐weighted mean values within the first 24 h in ICU for plasma Cl (Cl TWM 24 ). We analyzed the association of Cl TWM 24 primarily with the development of AKI , and secondarily with 90‐day mortality. Results Based on the first measured Cl value, 350 of 445 patients [78.7 (95 CI , 74.8–82.5)] had hyperchloremia (P‐Cl > 106 mmol/l) and 48 [10.8 (95 CI , 7.9–13.7)] severe hyperchloremia (P‐Cl > 114 mmol/l). Altogether 217 of 445 [48.8% (95% CI 44.2–53.4%)] patients developed AKI . Of these 217, AKI was diagnosed in 62 (28.6%) after 24 h from ICU admission and were included in the analysis regarding development of AKI . Cl TWM 24 was associated with an increased risk for the development of AKI ( OR 1.099; 1.003–1.205) after multivariable adjustments. According to Cl TWM 24 , no difference in 90‐day mortality between severely hyperchloremic patients and others existed. Conclusions More than three of four critically ill patients had hyperchloremia and 1 of 10 had its severe form. Higher time‐weighted mean chloride was independently associated with an increased risk for AKI .