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Published in: Pediatric Nephrology 7/2023

21-11-2022 | Acute Kidney Injury | Original Article

Hyperchloremia and association with acute kidney injury in critically ill children

Authors: Dylan Ginter, Elaine Gilfoyle, Andrew Wade, Brendan Cord Lethebe, Eli Gilad

Published in: Pediatric Nephrology | Issue 7/2023

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Abstract

Background

Hyperchloremia has been associated with acute kidney injury (AKI) in critically ill adult patients. Data is limited in pediatric patients. Our study sought to determine if an association exists between hyperchloremia and AKI in pediatric patients admitted to the intensive care unit (PICU).

Methods

This is a single-center retrospective cohort study of pediatric patients admitted to the PICU for greater than 24 h and who received intravenous fluids. Patients were excluded if they had a diagnosis of kidney disease or required kidney replacement therapy (KRT) within 6 h of admission. Exposures were hyperchloremia (serum chloride ≥ 110 mmol/L) within the first 7 days of PICU admission. The primary outcome was the development of AKI using the Kidney Disease Improving Global Outcomes (KDIGO) criteria. Secondary outcomes included time on mechanical ventilation, new KRT, PICU length of stay, and mortality. Outcomes were analyzed using multivariate logistic regression.

Results

There were 407 patients included in the study, 209 in the hyperchloremic group and 198 in the non-hyperchloremic group. Univariate analysis demonstrated 108 (51.7%) patients in the hyperchloremic group vs. 54 (27.3%) in the non-hyperchloremic group (p =  < .001) with AKI. On multivariate analysis, the odds ratio of AKI with hyperchloremia was 2.24 (95% CI 1.39–3.61) (p = .001). Hyperchloremia was not associated with increased odds of mortality, need for KRT, time on mechanical ventilation, or length of stay.

Conclusion

Hyperchloremia was associated with AKI in critically ill pediatric patients. Further pediatric clinical trials are needed to determine the benefit of a chloride restrictive vs. liberal fluid strategy.

Graphical abstract

Appendix
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Metadata
Title
Hyperchloremia and association with acute kidney injury in critically ill children
Authors
Dylan Ginter
Elaine Gilfoyle
Andrew Wade
Brendan Cord Lethebe
Eli Gilad
Publication date
21-11-2022
Publisher
Springer Berlin Heidelberg
Published in
Pediatric Nephrology / Issue 7/2023
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI
https://doi.org/10.1007/s00467-022-05823-8

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