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Hyperchloremia and association with acute kidney injury in critically ill children

Dylan Ginter1, Elaine Gilfoyle2, Andrew Wade3

  • 1Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.

Pediatric Nephrology (Berlin, Germany)
|November 21, 2022
PubMed

Insights

Hyperchloremia, or high chloride levels, is linked to acute kidney injury (AKI) in critically ill children. This study found a significant association, highlighting the need for further research into fluid strategies for pediatric intensive care unit patients.

Area of Science:

  • Pediatric critical care medicine
  • Nephrology
  • Intensive care medicine

Background:

  • Hyperchloremia is a known risk factor for acute kidney injury (AKI) in adult critically ill patients.
  • Limited data exists on the association between hyperchloremia and AKI in pediatric intensive care unit (PICU) populations.

Purpose of the Study:

  • To investigate the association between hyperchloremia and the development of AKI in pediatric patients admitted to the PICU.
  • To explore secondary outcomes including mechanical ventilation, kidney replacement therapy (KRT), PICU length of stay, and mortality.

Main Methods:

  • A single-center retrospective cohort study included pediatric patients admitted to the PICU for over 24 hours.
  • Hyperchloremia was defined as serum chloride ≥ 110 mmol/L within the first 7 days of admission.
  • AKI was diagnosed using Kidney Disease Improving Global Outcomes (KDIGO) criteria, with outcomes analyzed via multivariate logistic regression.

Main Results:

  • The study included 407 patients; 209 had hyperchloremia and 198 did not.
  • Patients with hyperchloremia showed a significantly higher incidence of AKI (51.7% vs. 27.3%, p < .001).
  • Multivariate analysis revealed hyperchloremia as an independent risk factor for AKI (OR 2.24, p = .001), but not associated with mortality, KRT, ventilation time, or length of stay.

Conclusions:

  • Hyperchloremia is significantly associated with AKI in critically ill pediatric patients.
  • Further pediatric clinical trials are warranted to evaluate the impact of chloride-restrictive versus liberal fluid strategies.
  • The findings emphasize the importance of monitoring serum chloride levels in pediatric ICU patients at risk for AKI.
Abstract

Keywords:
Acute kidney injuryHyperchloremiaKidney replacement therapyPediatric critical careRenal angina index

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