2021, Number 6
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Med Int Mex 2021; 37 (6)
Hypercloremia associated with acute renal injury in sepsis
León-Miranda AE, Lozano-Nuevo JJ, Ayala-San Pedro JA, Mendoza-Portillo E, Sánchez-Avilés TA, Velázquez-Navarrete KE
Language: Spanish
References: 21
Page: 938-945
PDF size: 189.32 Kb.
ABSTRACT
Background: Acute kidney injury occurs frequently in patients with sepsis, so
identifying risk factors may be useful to avoid this complication. One of factors that
have charged interest is the level of chlorine.
Objective: To determine the association between hyperchloremia and the development
of acute renal injury using negative chlorine delta as well as creatinine delta.
Materials and Methods: Fifty-six patients with sepsis (qSOFA ≥ 2), 28 with chlorine
≥ 110 (when admitted to the emergency room or at 72 h) and 28 with chlorine ‹ 110
were included. The chlorine delta and creatinine delta were analyzed establishing an
improvement in the creatinine level with a negative creatinine delta ‹ 0.04 mg/dL. Two
groups were established: patients with renal failure and without renal failure.
Results: An association was detected between the patients who observed hyperchloremia
with the development of renal failure (p = 0.04). We obtained an OR of 7
with a 95%CI of 0.8 to 65. In Pearson’s correlation between delta chlorine and delta
creatinine negative, a bilateral significance of 0.024 was obtained with an R of -0.3.
Conclusions: Acute renal injury is statistically significant associated with hyperchloremia
in patients with sepsis compared with normochloremia.
REFERENCES
Lopes JA, Jorge S, Resina C, Santos C, Pereira A, Neves J, Antunes F, Prata M. Acute kidney injury in patients with sepsis: a contemporary analysis. Int J Infect Dis 2009; 13: 176-81. doi: 10.1016/j.ijid.2008.05.1231.
Vanmassenhove J, Lameire N, Dhondt A, Vanholder R, Van Biesen W. Prognostic robustness of serum creatinine based AKI definitions in patients with sepsis: a prospective cohort study. BMC Nephrol 2015; 16: 112. doi: 10.1186/ s12882-015-0107-4.
Lopes JA, Fernandes P, Jorge S, Resina C, Santos C, et al. Long-term risk of mortality after acute kidney injury in patients with sepsis: a contemporary analysis. BMC Nephrol 2010; 11: 9. doi: 10.1186/1471-2369-11-9.
Linder A, Fjell C, Levin A, Walley KR, Russell JA, Boyd JH. Small acute increases in serum creatinine are associated with decreased long-term survival in the critically ill. Am J Respir Crit Care Med 2014; 189: 1075-1081. doi: 10.1164/ rccm.201311-2097OC.
Rhodes A, Evans LE, Alhazzani W, Levy M, Antonelli M, Ferreret R, al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Intensive Care Med 2017; 45: 3. doi: 10.1007/ s00134-017-4683-6.
Hammond NE, Taylor C, Saxena M, Liu B, et al. Resuscitation fluid use in Australian and New Zealand Intensive Care Units between 2007 and 2013. Intensive Care Med 2015; 41 (9): 1611-9. doi: 10.1007/s00134-015-3878.
Raghunathan K, Shaw A, Nathanson B, Sturmer T, Brookhart A, Stefan MS, et al. Association between the choice of IV crystalloid and in-hospital mortality among critically ill adults with sepsis. Crit Care Med 2014; 42 (7): 1585-1591. doi: 10.1097/CCM.0000000000000305.
Shaw AD, Raghunathan K, Peyerl FW, Munson SH, Paluszkiewicz SM, Schermer CR. Association between intravenous chloride load during resuscitation and in-hospital mortality among patients with SIRS. Intensive Care Med 2014; 40 (12): 1897-1905. doi: 10.1007/s00134-014-3505-3.
Boniatti MM, Cardoso PR, Castilho RK, Vieira SR. Is hyperchloremia associated with mortality in critically ill patients? A prospective cohort study. J Crit Care 2011; 26 (2): 175- 179. doi: 10.1016/j.jcrc.2010.04.013.
Neyra JA, Canepa-Escaro F, Li X, Manllo J, Adams-Huet B, Yee J, et al. Association of hyperchloremia with hospital mortality in critically ill septic patients. Care Med Crit 2015; 43 (9): 1938-1944. doi: 10.1097/CCM.0000000000001161.
Wauters J, Claus P, Brosens N, McLaughlin M, Malbrain M, Wilmer A. Pathophysiology of renal hemodynamics and renal cortical microcirculation in a porcine model of elevated intra-abdominal pressure. J Trauma 2009; 66 (3): 713-719. doi: 10.1097/TA.0b013e31817c5594.
Yunos NM, Bellomo R, Hegarty C, Story D, Ho L, Bailey M. Association between a chloride-liberal vs chloriderestrictive intravenous fluid administration strategy and kidney injury in critically ill adults. JAMA 2012; 308 (15): 1566-1572. doi: 10.1001/jama.2012.13356.
Zhang Z, Xu X, Fan H, Li D, Deng H, et al. Higher serum chloride concentrations are associated with acute kidney injury in unselected critically ill patients. BMC Nephrol. 2013; 14 (1): 1-6. doi: 10.1186/1471-2369-14-235.
Yessayan L, Neyra JA, Canepa-Escaro F, Vasquez-Rios G, et al. Effect of hyperchloremia on acute kidney injury in critically ill septic patients: a retrospective cohort study. BMC Nephrol 2017; 18: 346. doi: 10.1186/s12882-017-0750-z.
Bandarn S, Pisitsak C, Boyd JH, Russell JA, Walleyet KR. Hyperchloremia and moderate increase in serum chloride are associated with acute kidney injury in severe sepsis and septic shock patients. Crit Care 2016; 20: 315. doi: 10.1186/ s13054-016-1499-7.
Bertran EG. Manual de Metodología de la Investigación clínica. Paraguay-Buenos Aires: Akadai; 1995, pp. 70-86.
Downe NM, Heath RW. Métodos estadísticos aplicados. México: Harla; 1986.
Ley General de Salud. Última reforma publicada DOF 04-06-2014.
Declaration of Helsinki. 18th World Medical Assembly, Helsinki, Finland (June1964). https://es.wikipedia.org/ wiki/Declaración_de_Helsinki
29th World Medical Assembly, Tokyo, Japan (October 1975). www.cirp.org/library/ethics/tokyo
52nd World Medical Assembly, Edinburgh, Scotland (October 2000). www.wma.net/en/30publications/10policies/ b3/