Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, 166, Gumi-ro, Bundang-gu, Seongnam, 463-707, Republic of Korea.
Division of Nephrology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
Crit Care. 2018 Oct 30;22(1):277. doi: 10.1186/s13054-018-2216-5.
Whether perioperative hyperchloremia can induce postoperative acute kidney injury (AKI) is controversial. We investigated the association between perioperative hyperchloremia and postoperative AKI in patients admitted to the intensive care unit (ICU) after surgery.
We performed a retrospective observational study of patients admitted to the surgical ICU at a single tertiary care hospital between January 2011 and June 2016. Our primary objective was to determine whether hyperchloremia or an increase in serum chloride levels was associated with postoperative AKI. Perioperative hyperchloremia was defined as serum chloride levels ≥ 110 mmol·L during postoperative days (PODs) 0-3. The increase in serum chloride levels was defined as the difference between preoperative and maximum postoperative serum chloride levels during the first 3 days after surgery.
Of the 7991 patients included in the final analysis, 1876 (23.5%) developed hyperchloremia during PODs 0-3, and 1187 (14.9%) developed postoperative AKI. Exposure to hyperchloremia during the first 3 days after surgery was not associated with postoperative AKI (odds ratio, 1.09; 95% confidence interval, 0.80-1.49; P = 0.571). However, among patients with preoperative chronic kidney disease stage ≥ 3 (estimated glomerular filtration rate < 60 mL·min·1.73·m), the incidence of postoperative AKI was higher in patients with an increase > 6 mmol·L in serum chloride levels than in patients with an increase ≤ 1 mmol·L (odds ratio, 1.42; 95% confidence interval, 1.09-1.84; P = 0.009). In addition, the incidence of postoperative AKI stage ≥ 2 was not associated with exposure to hyperchloremia or with the increase in serum chloride levels during PODs 0-3, regardless of preoperative kidney function.
Exposure to perioperative hyperchloremia is not associated with postoperative AKI in surgical ICU patients. However, in patients with moderate-to-severe chronic kidney disease (stage ≥ 3), a substantial perioperative increase in serum chloride levels may reflect a higher risk of AKI.
围手术期高氯血症是否会引起术后急性肾损伤（AKI）存在争议。我们研究了手术后入住重症监护病房（ICU）的患者围手术期高氯血症与术后 AKI 之间的关系。
我们对 2011 年 1 月至 2016 年 6 月期间在一家三级护理医院外科 ICU 住院的患者进行了回顾性观察性研究。我们的主要目的是确定高氯血症或血清氯水平升高是否与术后 AKI 相关。围手术期高氯血症定义为术后第 0-3 天血清氯水平≥110mmol·L。血清氯水平升高定义为手术前和术后第 1-3 天内最大血清氯水平之间的差异。
在最终分析的 7991 例患者中，1876 例（23.5%）在术后第 0-3 天出现高氯血症，1187 例（14.9%）发生术后 AKI。术后第 1-3 天内暴露于高氯血症与术后 AKI 无关（比值比，1.09；95%置信区间，0.80-1.49；P=0.571）。然而，在术前慢性肾脏病 3 期及以上（估计肾小球滤过率<60ml·min·1.73·m）的患者中，血清氯水平升高>6mmol·L 的患者术后 AKI 的发生率高于血清氯水平升高≤1mmol·L 的患者（比值比，1.42；95%置信区间，1.09-1.84；P=0.009）。此外，术后 AKI 分期≥2 与围手术期高氯血症或术后第 0-3 天血清氯水平升高无关，与术前肾功能无关。
外科 ICU 患者围手术期暴露于高氯血症与术后 AKI 无关。然而，在中重度慢性肾脏病（3 期及以上）患者中，围手术期血清氯水平显著升高可能反映 AKI 的风险较高。
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