Yessayan Lenar, Neyra Javier A, Canepa-Escaro Fabrizio, Vasquez-Rios George, Heung Michael, Yee Jerry
Division of Nephrology, University of Michigan, 3914 Taubman Center, 1500 E. Medical Center Dr. 5364, Ann Arbor, MI, 48109-5364, USA.
Division of Nephrology, Bone and Mineral Metabolism, University of Kentucky Medical Center, Lexington, KY, USA.
BMC Nephrol. 2017 Dec 2;18(1):346. doi: 10.1186/s12882-017-0750-z.
Hyperchloremia is common in critically ill septic patients. The impact of hyperchloremia on the incidence of acute kidney injury (AKI) is not well studied. We investigated the association between hyperchloremia and AKI within the first 72 h of intensive care unit (ICU) admission.
6490 ICU adult patients admitted with severe sepsis or septic shock were screened for eligibility. Exclusion criteria included: AKI on admission, baseline estimated glomerular filtration rate (eGFR) <15 ml/min/1.73 m, chronic renal replacement therapy, absent baseline serum creatinine data, and absent serum chloride data on ICU admission.
A total of 1045 patients were available for analysis following the implementation of eligibility criteria: 303 (29%) had hyperchloremia (Cl ≥ 110 mEq/L) on ICU admission, 561 (54%) were normochloremic (Cl 101-109 mEq/L) and 181 (17%) were hypochloremic (Cl ≤ 100 mEq/L). AKI within the first 72 h of ICU stay was the dependent variable. Chloride on ICU admission (Cl) and change in Cl by 72 h (ΔCl = Cl - Cl) were the independent variables. The odds for AKI were not different in the hyperchloremic group when compared to the normochloremic group [adjusted odds ratio (OR) =0.80, 95% confidence interval [CI] (0.51-1.25); p = 0.33] after adjusting for demographics, comorbidities, baseline kidney function, drug exposure and critical illness indicators including cumulative fluid balance and base deficit. Furthermore, within the subgroup of patients with hyperchloremia on ICU admission, neither Cl nor ΔCl was associated with AKI or with moderate/severe AKI (KDIGO Stage ≥2).
Hyperchloremia occurs commonly among critically ill septic patients admitted to the ICU, but does not appear to be associated with an increased risk for AKI within the first 72 h of admission.
高氯血症在重症脓毒症患者中很常见。高氯血症对急性肾损伤（AKI）发生率的影响尚未得到充分研究。我们调查了重症监护病房（ICU）入院后72小时内高氯血症与AKI之间的关联。
对6490例因严重脓毒症或脓毒性休克入住ICU的成年患者进行筛选以确定其是否符合条件。排除标准包括：入院时存在AKI、基线估计肾小球滤过率（eGFR）<15 ml/min/1.73 m²、慢性肾脏替代治疗、缺乏基线血清肌酐数据以及ICU入院时缺乏血清氯数据。
在实施纳入标准后，共有1045例患者可供分析：303例（29%）在ICU入院时存在高氯血症（Cl≥110 mEq/L），561例（54%）为血氯正常（Cl 101 - 109 mEq/L），181例（17%）为低氯血症（Cl≤100 mEq/L）。ICU住院72小时内发生的AKI为因变量。ICU入院时的氯（Cl）以及72小时时氯的变化（ΔCl = 72小时时的Cl - 入院时的Cl）为自变量。在对人口统计学、合并症、基线肾功能、药物暴露以及包括累计液体平衡和碱缺失在内的危重病指标进行调整后，高氯血症组发生AKI的几率与血氯正常组相比无差异[调整后的优势比（OR）=0.80，95%置信区间[CI]（0.51 - 1.25）；p = 0.33]。此外，在ICU入院时存在高氯血症的患者亚组中，Cl和ΔCl均与AKI或中度/重度AKI（KDIGO分期≥2）无关。
高氯血症在入住ICU的重症脓毒症患者中很常见，但在入院后72小时内似乎与AKI风险增加无关。
