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

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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.

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Author information

Authors and Affiliations

  1. Division of Critical Care, Children’s Hospital Colorado, Aurora, CO, USA

    Matthew F. Barhight, Jennifer Lusk, Timothy Stidham & Peter M. Mourani

  2. Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA

    Matthew F. Barhight, Timothy Stidham, Danielle E. Soranno, Jens Goebel, Peter M. Mourani & Katja M. Gist

  3. Department of Biostatistics and Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA

    John Brinton

  4. Division of Nephrology, Children’s Hospital Colorado, Aurora, CO, USA

    Danielle E. Soranno, Sarah Faubel & Jens Goebel

  5. Division of Renal Disease and Hypertension, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA

    Danielle E. Soranno & Sarah Faubel

  6. Division of Cardiology, Children’s Hospital Colorado, Aurora, CO, USA

    Katja M. Gist

  7. The Heart Institute, Children’s Hospital Colorado, 13123 E. 16th Ave, Box 100, Aurora, CO, 80045-2535, USA

    Katja M. Gist

Authors
  1. Matthew F. Barhight
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  2. Jennifer Lusk
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  3. John Brinton
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  4. Timothy Stidham
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  7. Jens Goebel
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  8. Peter M. Mourani
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Corresponding author

Correspondence to Katja M. Gist.

Ethics declarations

The University of Colorado Multiple Institutional Review Board approved the study with a waiver of informed consent.

Conflict of interest

The authors have no financial or ethical conflicts of interest to disclose.

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Barhight, M.F., Lusk, J., Brinton, J. et al. Hyperchloremia is independently associated with mortality in critically ill children who ultimately require continuous renal replacement therapy. Pediatr Nephrol 33, 1079–1085 (2018). https://doi.org/10.1007/s00467-018-3898-2

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  • DOI: https://doi.org/10.1007/s00467-018-3898-2

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