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Published on: March 27, 2018
Hyperchloremia is associated with poor renal outcome after coronary artery bypass grafting
Jae Shin Choi1, Donghwan Yun2, Dong Ki Kim3
1Department of Internal Medicine, Pyeongtaek St. Mary's Hospital, Gyeonggi-do, Korea.
Insights
Preoperative hyperchloremia increases the risk of acute kidney injury (AKI) and end-stage renal disease (ESRD) after coronary artery bypass grafting (CABG). Monitoring serum chloride levels is recommended for patients undergoing CABG.
Area of Science:
- Nephrology
- Cardiology
- Critical Care Medicine
Background:
- Hyperchloremia is linked to increased morbidity and mortality.
- The association between hyperchloremia and kidney outcomes (AKI, ESRD) post-CABG is not well-established.
Purpose of the Study:
- To investigate the relationship between preoperative serum chloride levels and the incidence of AKI and ESRD in patients undergoing CABG.
- To determine if hyperchloremia is an independent risk factor for adverse renal outcomes after CABG.
Main Methods:
- Retrospective review of 2977 patients who underwent CABG.
- Categorization of patients based on serum chloride levels: normochloremia, mild hyperchloremia, and severe hyperchloremia.
- Statistical analysis using adjusted odds ratios (ORs) for AKI and hazard ratios (HRs) for ESRD.
Main Results:
- Postoperative AKI occurred in 26.5% of patients.
- Hyperchloremia was associated with a dose-dependent increased risk of AKI (ORs 1.26-1.95).
- Severe hyperchloremia significantly increased the risk of ESRD (HR 2.43), even after adjusting for mortality.
Conclusions:
- Preoperative hyperchloremia is a significant predictor of poor renal outcomes, including AKI and ESRD, following CABG.
- Serum chloride monitoring is crucial for risk stratification and management in patients undergoing CABG.
- This study highlights the importance of electrolyte balance in cardiac surgery patients.
Background:
Hyperchloremia is associated with the risks of several morbidities and mortality. However, its relationship with acute kidney injury (AKI) and end-stage renal disease (ESRD) in patients undergoing coronary artery bypass grafting (CABG) remains unresolved.
Methods:
A total of 2977 patients undergoing CABG between 2003 and 2015 were retrospectively reviewed from two tertiary hospitals. Patients were categorized by serum chloride levels into normochloremia (95-105 mmol/L), mild hyperchloremia (106-110 mmol/L), and severe hyperchloremia (> 110 mmol/L). The odds ratios (ORs) for AKI and hazard ratios (HRs) for ESRD were calculated after adjustment for multiple covariates. The death-adjusted risk of ESRD was additionally evaluated.
Results:
Postoperative AKI occurred in 798 patients (26.5%). The hyperchloremia group had a higher risk of AKI than the normochloremia group, wherein the risk was incremental depending on the severity of hyperchloremia, as follows: ORs were 1.26 (1.06-1.51) and 1.95 (1.52-2.51) in the mild and severe hyperchloremia groups, respectively. During a median period of 7 years (maximum 15 years), 70 patients (2.3%) had ESRD. The severe hyperchloremia group was at an elevated risk of ESRD compared with the normochloremia group, with an HR of 2.43 (1.28-4.63). Even after adjusting for the competing risk of death, hyperchloremia was associated with the risk of ESRD.
Conclusions:
Preoperative hyperchloremia is associated with poor renal outcomes such as AKI and ESRD after CABG. Accordingly, serum chloride should be monitored in patients undergoing CABG.
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