Hyperchloremia as an Indicator for Acute Kidney Injury in Critically Ill Septic Patients

Document Type : Original Article


The Department of Anaesthesiology, Intensive Care and Pain Management, Faculty of Medicine, Ain Shams University


Abstract Background: Crystalloid solution therapy, including nor-mal saline, is recommended for the early therapy of sepsis and septic shock. Shock is a state of circulatory failure that appears with hypotension as well as other vital sign deterioration or the presence of increased serum lactate levels. With recently pro-posed adverse outcomes and accusations of acute kidney injury, normal saline, which contains 154mmol/L of both sodium and chloride, has been accused of causing hyperchloremic acidosis in the past. Aim of Study: Defining whether there is a relationship be-tween Cl level at three different time points of the ICU, at ICU admission (Cl0), 24 hours after the ICU admission (Cl24h), and 48 hours after the ICU admission (Cl48h) and the development of acute kidney injury in critically ill patients with sepsis resus-citat-ed with isotonic saline (NaCl 0.9%). Patients and Methods: This study included 70 ICU adult septic patients screened for eligibility. Results: There was not a significant relationship between chloride level at three-time points: Day 0 (CL0), day 1 (CL24), and day 2 (CL48) and AKI among the studied cases (p=0.11); we found that there was a significant relationship between se-verity scoring systems e.g., APACHE and qSOFA with AKI on admission and 48 hours later. Regarding kidney function tests, we concluded that maintenance fluid volumes (MFV), urine output (UOP), serum lactate level, and anion gap all showed a significant rela-tionship with AKI (p<0.001). Even though PH and HCO3 showed a significant relationship with AKI (p<0.001), meanwhile; PCO2 showed a non-significant rela-tionship with AKI (p=0.021). Conclusion: A non-significant relationship was found be-tween chloride level and AKI, neither on admission nor 24 or 48 hours later; chloride level could not be used as a predictor of AKI among critically ill septic patients.