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Hyperchloremia Is Associated With Acute Kidney Injury in Patients With Subarachnoid Hemorrhage

Ofer Sadan¹, Kai Singbartl, Prem A Kandiah

¹1Department of Neurology and Neurosurgery, Emory University School of Medicine and Emory University Hospital, Atlanta, GA.2Department of Critical Care Medicine, Mayo Clinic, Phoenix, AZ.3Department of Anesthesiology, Penn State College of Medicine, Hershey, PA.4Center for Critical Care Nephrology, University of Pittsburgh, Pittsburgh, PA.

Critical Care Medicine

|May 16, 2017

Abstract

Objective:

To assess the prevalence of acute kidney injury in patients with subarachnoid hemorrhage patients.

Design:

Retrospective analysis of all subarachnoid hemorrhage admissions.

Settings:

Neurocritical care unit.

Patients:

All patients with a diagnosis of subarachnoid hemorrhage between 2009 and 2014.

Interventions:

None.

Measurements And Main Results:

Of 1,267 patients included in this cohort, 16.7% developed acute kidney injury, as defined by Kidney Disease Improving Global Outcome criteria (changes in creatinine only). Compared to patients without acute kidney injury, patients with acute kidney injury had a higher prevalence of diabetes mellitus (21.2% vs 9.8%; p < 0.001) and hypertension (70.3% vs 50.5%; p < 0.001) and presented with higher admission creatinine concentrations (1.21 ± 0.09 vs 0.81 ± 0.01 mg/dL [mean ± SD], respectively; p < 0.001). Patients with acute kidney injury also had higher mean serum chloride and sodium concentrations during their ICU stay (113.4 ± 0.6 vs 107.1 ± 0.2 mmol/L and 143.3 ± 0.4 vs 138.8 ± 0.1 mmol/L, respectively; p < 0.001 for both), but similar chloride exposure. The mortality rate was also significantly higher in patients with acute kidney injury (28.3% vs 6.1% in the non-acute kidney injury group [p < 0.001]). Logistic regression analysis revealed that only male gender (odds ratio, 1.82; 95% CI, 1.28-2.59), hypertension (odds ratio, 1.64; 95% CI, 1.11-2.43), diabetes mellitus (odds ratio, 1.88; 95% CI, 1.19-2.99), abnormal baseline creatinine (odds ratio, 2.48; 95% CI, 1.59-3.88), and increase in mean serum chloride concentration (per 10 mmol/L; odds ratio, 7.39; 95% CI, 3.44-18.23), but not sodium, were associated with development of acute kidney injury. Kidney recovery was noted in 78.8% of the cases. Recovery reduced mortality compared to non-recovering subgroup (18.6% and 64.4%, respectively; p < 0.001).

Conclusions:

Critically ill patients with subarachnoid hemorrhage show a strong association between hyperchloremia and acute kidney injury as well as acute kidney injury and mortality.

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