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Hyperchloremia and postoperative acute kidney injury: a retrospective analysis of data from the surgical intensive care unit

Cited 4 time in Web of Science Cited 2 time in Scopus
Authors
Oh, Tak Kyu; Song, In-Ae; Kim, Se Joong; Lim, Sung Yoon; Do, Sang-Hwan; Hwang, Jung-Won; Kim, Jinhee; Jeon, Young-Tae
Issue Date
2018-10-30
Publisher
BioMed Central
Citation
Critical Care, 22(1):277
Keywords
Acute kidney injuryCritical careHyperchloremiaIntensive care unit
Abstract
Background
Whether perioperative hyperchloremia can induce postoperative acute kidney injury (AKI) is controversial. We investigated the association between perioperative hyperchloremia and postoperative AKI in patients admitted to the intensive care unit (ICU) after surgery.

Methods
We performed a retrospective observational study of patients admitted to the surgical ICU at a single tertiary care hospital between January 2011 and June 2016. Our primary objective was to determine whether hyperchloremia or an increase in serum chloride levels was associated with postoperative AKI. Perioperative hyperchloremia was defined as serum chloride levels ≥ 110 mmol·L− 1 during postoperative days (PODs) 0–3. The increase in serum chloride levels was defined as the difference between preoperative and maximum postoperative serum chloride levels during the first 3 days after surgery.

Results
Of the 7991 patients included in the final analysis, 1876 (23.5%) developed hyperchloremia during PODs 0–3, and 1187 (14.9%) developed postoperative AKI. Exposure to hyperchloremia during the first 3 days after surgery was not associated with postoperative AKI (odds ratio, 1.09; 95% confidence interval, 0.80–1.49; P = 0.571). However, among patients with preoperative chronic kidney disease stage ≥ 3 (estimated glomerular filtration rate < 60 mL·min− 1·1.73·m− 2), the incidence of postoperative AKI was higher in patients with an increase > 6 mmol·L− 1 in serum chloride levels than in patients with an increase ≤ 1 mmol·L− 1 (odds ratio, 1.42; 95% confidence interval, 1.09–1.84; P = 0.009). In addition, the incidence of postoperative AKI stage ≥ 2 was not associated with exposure to hyperchloremia or with the increase in serum chloride levels during PODs 0–3, regardless of preoperative kidney function.

Conclusions
Exposure to perioperative hyperchloremia is not associated with postoperative AKI in surgical ICU patients. However, in patients with moderate-to-severe chronic kidney disease (stage ≥ 3), a substantial perioperative increase in serum chloride levels may reflect a higher risk of AKI.
ISSN
1364-8535
Language
English
URI
http://hdl.handle.net/10371/146881
DOI
https://doi.org/10.1186/s13054-018-2216-5
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College of Medicine/School of Medicine (의과대학/대학원)Anesthesiology and Pain Medicine (마취통증의학전공)Journal Papers (저널논문_마취통증의학전공)
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