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Impact of chloride-rich crystalloids on sepsis-associated community-acquired acute kidney injury recovery in critically ill patients

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Abstract

Background

The use of chloride-rich crystalloids for resuscitation is associated with acute kidney injury (AKI). We aimed to explore the impact of resuscitation with chloride-rich crystalloids compared to balanced crystalloids on kidney function recovery in patients presenting with sepsis-associated community-acquired AKI (SACA-AKI).

Methods

This is a single-center, historical cohort study of the adult intensive care unit (ICU) patients who presented to the emergency department (ED) with  sepsis-associated community-acquired-AKI at the Mayo Clinic, Rochester, MN, from January 2011 to April 2018. We divided the cohort into two groups based on the primary type of crystalloids they received in the ED and the first 48-h of ICU. The first group received primarily normal saline with < 25% balanced solutions, and the second group received at least ≥ 25% balanced crystalloids during the initial volume resuscitation.

Results

Among the 732 enrolled patients [mean age: 64 ± 17, males: 461(63%)], 255 (35%) were in the second group and were found to have higher positive fluid balance during the first 48-h of admission compared to the first group [median + 2.3 (IQR: 0.4; 4.5) vs. + 1.1 (IQR: − 0.8; + 2.9) L, p < 0.001]. The second group had a higher rate of kidney function recovery by multivariate logistic regression after adjustments for known recovery risk factors (OR 1.46; 95% CI 1.05–2.04, p = 0.02).

Conclusions

The use of balanced crystalloids during the initial resuscitation is associated with higher odds of kidney function recovery in AKI patients with sepsis-associated community-acquired AKI.

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Acknowledgements

We would like to thank Dr. Juan Pablo Domecq Garces and Dr. Kimberly R. Johnson for their support. This project was supported in part by the National Institute of Allergy and Infectious Diseases of the National Institutes of Health under Award Number K23AI143882 (PI; EFB).

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Authors and Affiliations

  1. Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Shahrzad Tehranian, Khaled Shawwa & Kianoush Kashani

  2. Department of Pharmacy, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA

    Erin F. Barreto

  3. Department of Emergency Medicine, Mayo Clinic, Rochester, MN, USA

    Casey M. Clements

  4. Department of Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA

    Kianoush Kashani

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  1. Shahrzad Tehranian
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  2. Khaled Shawwa
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Correspondence to Kianoush Kashani.

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This study has been reviewed and approved by the local Institutional Review Boardand. This study is conducted in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its associated amendment.

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Tehranian, S., Shawwa, K., Barreto, E.F. et al. Impact of chloride-rich crystalloids on sepsis-associated community-acquired acute kidney injury recovery in critically ill patients. J Nephrol 35, 285–292 (2022). https://doi.org/10.1007/s40620-021-01060-8

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