Hyperchloremia is independently associated with mortality in critically ill children who ultimately require continuous renal replacement therapy

Matthew Franklin Barhight, Jennifer Lusk, John Brinton, Timothy Stidham, Danielle E. Soranno, Sarah Faubel, Jens Goebel, Peter M. Mourani, Katja M. Gist*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

Background: The optimal fluid management in critically ill children is currently under investigation with several studies suggesting that hyperchloremia, chloride load, and the use of chloride-rich fluids contribute to worse outcomes. Methods: This is a single-center retrospective cohort study of Pediatric Intensive Care Unit patients from 2008 to 2016 requiring continuous renal replacement therapy (CRRT). Patients were excluded if they had end-stage renal disease, a disorder of chloride transport, or concurrent provision of extracorporeal membrane oxygenation therapy. Results: Patients (n = 66) were dichotomized into two groups (peak chloride (Cl) ≥ 110 mmol/L vs. peak Cl < 110 mmol/L prior to CRRT initiation). Hyperchloremia was present in 39 (59%) children. Baseline characteristics were similar between groups. Fluid overload at CRRT initiation was more common in patients with hyperchloremia (11.5% IQR 3.8–22.4) compared to those without (5.5% IQR 0.9–13.9) (p = 0.04). Mortality was significantly higher in patients with hyperchloremia (n = 26, 67%) compared to those without (n = 8, 29%) (p = 0.006). Patients with hyperchloremia had 10.9 times greater odds of death compared to those without hyperchloremia, after adjusting for percent fluid overload, PRISM III score, time to initiation of CRRT, height, and weight (95% CI 2.4 to 49.5, p = 0.002). Conclusions: Hyperchloremia is common among critically ill children prior to CRRT initiation. In this population, hyperchloremia is independently associated with mortality. Further studies are needed to determine the impact of hyperchloremia on all critically ill children and the impact of chloride load on outcomes.

Original languageEnglish (US)
Pages (from-to)1079-1085
Number of pages7
JournalPediatric Nephrology
Volume33
Issue number6
DOIs
StatePublished - Jun 1 2018

Keywords

  • Acute kidney injury
  • Continuous renal replacement therapy (CRRT)
  • Fluid overload
  • Hyperchloremia
  • Mortality
  • Pediatrics

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Nephrology

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