Table 5.
Retrospective studies evaluating the association between serum chloride concentration and AKI across different clinical settings
| Study Description | Key Results | Comments | Association With AKI |
|---|---|---|---|
| Surgery | |||
| Single-center study in 726 patients who underwent craniotomy for a brain tumor resection (147) | Perioperative hyperchloremia was associated with postoperative AKI | 39 patients with AKI | Yes |
| Organ transplantation | |||
| Single-center study of 213 donors and kidney allograft recipients (221) | No association between terminal serum chloride concentration in the deceased donor and kidney allograft function in the recipient up to 1 mo posttransplant | 127 donors had hyperchloremia | No |
| Dose of norepinephrine was higher in donors with hyperchloremia | |||
| Sepsis | |||
| Single-center cohort study of 240 patients with severe sepsis or septic shock (209) | Change in serum chloride concentration ≥5 mEq/l was associated with 5.7× higher odds of AKI after multivariable analysis | Excluded patients with chronic kidney disease (CKD) | Yes |
| The average fluid volume administered per patient was 4.8 liters, and a greater increase in chloride was associated with more severe AKI | A trend was observed for the association between hyperchloremia and the need for RRT | ||
| Patients without hyperchloremia but who had an increase in chloride ≥5 mEq/l showed 8.3× higher odds of developing AKI | |||
| Single-center study of 1,045 ICU patients with severe sepsis or septic shock (246) | No association of admission hyperchloremia, hypochloremia, or change in serum chloride with AKI within the 1st 72 h of admission | Median cumulative fluid balance in the 1st 72 h of ICU stay was slightly over 2 liters, and mean APACHE II score was ~13 | No |
| Single-center study of baseline serum chloride levels in 834 septic patients (144) | More AKI in hypochloremic and hyperchloremic groups compared with normochloremic group | ~1.5 liters mean daily infused normal saline volume in all groups | Yes |
| Single-center cohort study of 1,221 critically ill patients (258) | AKI was associated with mean and maximum serum chloride concentrations | AKI in 357 patients | Yes |
| The most severe AKI was associated with a maximum serum chloride of 116 mEq/l | |||
| Contrast nephropathy | |||
| Single-center study of 401 patients admitted with ST-segment myocardial infarction undergoing percutaneous coronary intervention (154) | Baseline hyperchloremia was not associated with increased risk for postprocedure AKI | Did not report on IV fluid administration | No |
| Single-center analysis of 13,088 patients, mostly hospitalized, who underwent a contrast-enhanced abdominal computed tomography scan (143) | Increased risk of contrast-induced AKI in patients with baseline hypochloremia and normal serum creatinine (<1.2 mg/dl) | Low incidence of hyperchloremia in only 248 (1.8%) patients | Yes |
| In those with hypochloremia, a positive change in serum chloride within 72 h after contrast exposure was associated with decreased AKI incidence | |||
| Congestive heart failure | |||
| Analysis of 2 cohorts with 1,318 and 876 patients admitted for acute decompensated congestive heart failure (CHF) (58) | Admission serum chloride levels <99 compared with >103 mEq/l were associated with slightly higher admission creatinine (1.3 vs. 1.2 mg/dl) in 1 of the 2 cohorts | Serum chloride tertiles were also inversely associated with mortality, systolic blood pressure, and blood urea nitrogen | Yes |
| Post hoc analysis of a double-blind randomized controlled trial (RCT) of 2,699 chronic stable CHF patients (216) | Hypochloremia was associated with higher baseline serum creatinine, lower glomerular filtration rate (GFR) and a greater percentage of patients with eGFR <60 ml·min−1·1.73 m−2 | Interestingly, no association was seen between hyponatremia and renal function | Yes |
| Post hoc analysis of an RCT of 1,960 patients hospitalized with acute decompensated CHF (212) | No association between baseline chloride and subsequent worsening renal function during decongestion | 279 patients had hypochloremia Lower serum chloride concentration was associated with poorer diuretic response | No |
| Single-center analysis of 277 patients diagnosed with pulmonary arterial hypertension (134) | Serum chloride ≤100 mEq/l 6 mo after diagnosis was associated with higher mortality and worse renal function than those with a serum chloride >100 mEq/l | The lower chloride group was older, with decreased functional capacity, took more diuretics, had higher pulmonary artery wedge pressure but lower mean pulmonary artery pressure, transpulmonary gradient, and pulmonary vascular resistance | Yes |