Association between chloride content of intravenous fluids and acute kidney injury in critically ill medical patients with sepsis

Jaynes, Megan; Murphy, Claire V.; Ali, Naeem; Krautwater, Annalise; Lehman, Amy; Doepker, Bruce

doi:10.1016/j.jcrc.2017.12.014

Cited by 18 publications

(33 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…It is well known that increases in Cl − levels after ICU admission are associated with the development of AKI [13,14,15], while the association between a decrease in Cl − levels and the development of AKI has not been extensively studied. Critically ill patients may experience a reduction in Cl − levels after ICU admission due to the active loss of Cl − in the gastrointestinal tract, impaired renal Cl − reabsorption, hypotonic fluid infusion, excessive diuretics therapy, and malnutrition [16,17].…”

Section: Introductionmentioning

confidence: 99%

Fluctuations in Serum Chloride and Acute Kidney Injury among Critically Ill Patients: A Retrospective Association Study

Song

Jeon

et al. 2019

JCM

View full text Add to dashboard Cite

Exposure to dyschloremia among critically ill patients is associated with an increased risk of acute kidney injury (AKI). We aimed to investigate how fluctuations in serum chloride (Cl−) are associated with the development of AKI in critically ill patients. We retrospectively analyzed medical records of adult patients admitted to the intensive care unit (ICU) between January 2012 and December 2017. Positive and negative fluctuations in Cl− were defined as the difference between the baseline Cl- and maximum Cl- levels and the difference between the baseline Cl− and minimum Cl− levels measured within 72 h after ICU admission, respectively. In total, 19,707 patients were included. The odds of developing AKI increased 1.06-fold for every 1 mmol L−1 increase in the positive fluctuations in Cl− (odds ratio: 1.06; 95% confidence interval: 1.04 to 1.08; p < 0.001) and 1.04-fold for every 1 mmol L−1 increase in the negative fluctuations in Cl− (odds ratio: 1.04; 95% confidence interval: 1.02 to 1.06; p < 0.001). Increases in both the positive and negative fluctuations in Cl- after ICU admission were associated with an increased risk of AKI. Furthermore, these associations differed based on the functional status of the kidneys at ICU admission or postoperative ICU admission.

show abstract

Section: Introductionmentioning

confidence: 99%

Fluctuations in Serum Chloride and Acute Kidney Injury among Critically Ill Patients: A Retrospective Association Study

Song

Jeon

et al. 2019

JCM

View full text Add to dashboard Cite

show abstract

“…However, accumulating evidence suggests patients are at risk of adverse effects to acid-base homeostasis, renal vasoconstriction, reduced glomerular filtration rate, increased risk of acute kidney injury, and death. [168][169][170][171][172][173] Based on this research, a supraphysiologic chloride concentration of saline could be a potential contributor to kidney injury. 174 Two large-scale studies investigated the effect of balanced crystalloids and saline in critical and noncritical populations: the Isotonic Solutions and Major Adverse Renal Events Trial (SMART), examined using balanced crystalloids versus saline in patients in medical (SMART-MED) and nonmedical (SMART-SURG) ICUs; and the Saline against Lactated Ringer's or Plasma-Lyte in the Emergency Department (SALT-ED) trial.…”

Section: Impact Of Intravenous Fluid Compositionmentioning

confidence: 89%

Perioperative Acute Kidney Injury

Gumbert

Kork²,

Jackson³

et al. 2020

Anesthesiology

208

138

View full text Add to dashboard Cite

Perioperative organ injury is among the leading causes of morbidity and mortality of surgical patients. Among different types of perioperative organ injury, acute kidney injury occurs particularly frequently and has an exceptionally detrimental effect on surgical outcomes. Currently, acute kidney injury is most commonly diagnosed by assessing increases in serum creatinine concentration or decreased urine output. Recently, novel biomarkers have become a focus of translational research for improving timely detection and prognosis for acute kidney injury. However, specificity and timing of biomarker release continue to present challenges to their integration into existing diagnostic regimens. Despite many clinical trials using various pharmacologic or nonpharmacologic interventions, reliable means to prevent or reverse acute kidney injury are still lacking. Nevertheless, several recent randomized multicenter trials provide new insights into renal replacement strategies, composition of intravenous fluid replacement, goal-directed fluid therapy, or remote ischemic preconditioning in their impact on perioperative acute kidney injury. This review provides an update on the latest progress toward the understanding of disease mechanism, diagnosis, and managing perioperative acute kidney injury, as well as highlights areas of ongoing research efforts for preventing and treating acute kidney injury in surgical patients.

show abstract

“…Although Plasma-Lyte 148 is almost three times more costly than saline, lactated Ringer's is available at approximately the same purchase price as saline. The majority of patients in most published studies who were prescribed a balanced crystalloid received lactated Ringer's (1,(4)(5)(6). Given the significant costs associated with poor clinical outcomes and adverse events during critical illness, using lactated Ringer's in critically ill patients with sepsis is likely to be a substantially cost-effective intervention in most scenarios.…”

Section: Major Adverse Kidney Events In 30 Daysmentioning

confidence: 99%

“…When prior data are considered alongside the SMART post hoc analysis, the benefit on short-term mortality appears less certain, although potentially still impactful (odds ratio [OR], 0.88; 95% confidence interval [CI], 0.76-1.01) (1, 3-5) (Figure 1). We have greater confidence in the decreased odds of patients developing acute kidney injury (OR, 0.67; 95% CI, 0.49-0.92) but uncertainty regarding progression to receipt of renal replacement therapy (OR, 0.85; 95% CI, 0.71-1.03) when receiving balanced crystalloids (1,(4)(5)(6). Although two of the three individual outcomes did not show significance, there was a lower incidence of major adverse kidney events in 30 days with balanced crystalloids compared with saline (OR, 0.78; 95% CI, 0.65-0.94) in the two studies that evaluated this outcome (1,6).…”

mentioning

confidence: 99%