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01-06-2018 | Original Article

Hyperchloremia is independently associated with mortality in critically ill children who ultimately require continuous renal replacement therapy

Authors: Matthew F. Barhight, Jennifer Lusk, John Brinton, Timothy Stidham, Danielle E. Soranno, Sarah Faubel, Jens Goebel, Peter M. Mourani, Katja M. Gist

Published in: Pediatric Nephrology | Issue 6/2018

Abstract

Background

The optimal fluid management in critically ill children is currently under investigation with several studies suggesting that hyperchloremia, chloride load, and the use of chloride-rich fluids contribute to worse outcomes.

Methods

This is a single-center retrospective cohort study of Pediatric Intensive Care Unit patients from 2008 to 2016 requiring continuous renal replacement therapy (CRRT). Patients were excluded if they had end-stage renal disease, a disorder of chloride transport, or concurrent provision of extracorporeal membrane oxygenation therapy.

Results

Patients (n = 66) were dichotomized into two groups (peak chloride (Cl) ≥ 110 mmol/L vs. peak Cl < 110 mmol/L prior to CRRT initiation). Hyperchloremia was present in 39 (59%) children. Baseline characteristics were similar between groups. Fluid overload at CRRT initiation was more common in patients with hyperchloremia (11.5% IQR 3.8–22.4) compared to those without (5.5% IQR 0.9–13.9) (p = 0.04). Mortality was significantly higher in patients with hyperchloremia (n = 26, 67%) compared to those without (n = 8, 29%) (p = 0.006). Patients with hyperchloremia had 10.9 times greater odds of death compared to those without hyperchloremia, after adjusting for percent fluid overload, PRISM III score, time to initiation of CRRT, height, and weight (95% CI 2.4 to 49.5, p = 0.002).

Conclusions

Hyperchloremia is common among critically ill children prior to CRRT initiation. In this population, hyperchloremia is independently associated with mortality. Further studies are needed to determine the impact of hyperchloremia on all critically ill children and the impact of chloride load on outcomes.

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Title: Hyperchloremia is independently associated with mortality in critically ill children who ultimately require continuous renal replacement therapy
Authors: Matthew F. Barhight
Jennifer Lusk
John Brinton
Timothy Stidham
Danielle E. Soranno
Sarah Faubel
Jens Goebel
Peter M. Mourani
Katja M. Gist
Publication date: 01-06-2018
Publisher: Springer Berlin Heidelberg
Published in: Pediatric Nephrology / Issue 6/2018
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI: https://doi.org/10.1007/s00467-018-3898-2

At a glance: The STEP trials

Springer Medicine

Hyperchloremia is independently associated with mortality in critically ill children who ultimately require continuous renal replacement therapy

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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