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High versus low chloride load in adult hyperglycemic emergencies with acute kidney injury: a multicenter retrospective cohort study

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Abstract

Hyperglycemic emergencies frequently lead to acute kidney injury (AKI) and require treatment with large amount of intravenous fluids. However, the effects of chloride loading on this population have not yet been investigated. We conducted a multicenter, retrospective, cohort study in 21 acute-care hospitals in Japan. The study included hospitalized adult patients with diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic syndrome (HHS) who had AKI upon arrival. The patients were classified into high and low chloride groups based on the amount of chloride administered within the first 48 h of their arrival. The primary outcome was recovery from AKI; secondary outcome was major adverse kidney events within 30 days (MAKE30), including mortality and prolonged renal failure. A total of 390 patients with AKI, including 268 (69%) with DKA and 122 (31%) with HHS, were included in the study. Using the criteria of Kidney Disease Improving Global Outcomes, the severity of AKI in the patients was Stage 1 (n = 159, 41%), Stage 2 (n = 121, 31%), and Stage 3 (n = 110, 28%). The analysis showed no significant difference between the two groups in recovery from AKI (adjusted hazard ratio, 0.96; 95% CI 0.72–1.28; P = 0.78) and in MAKE30 (adjusted odds ratio, 0.91; 95% CI 0.45–1.76; P = 0.80). Chloride loading with fluid administration had no significant impact on recovery from AKI in patients with hyperglycemic emergencies.

Trial Registration This study was registered in the UMIN clinical trial registration system (UMIN000025393, registered December 23, 2016).

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Data availability

The data sets used and analyzed in the current study are available from the corresponding author upon reasonable request.

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Acknowledgements

We would like to thank Editage (www.editage.jp) for English language editing.

Funding

Not applicable.

Author information

Author notes

  1. Kyosuke Takahashi and Norimichi Uenishi contributed equally as first authors.

Authors and Affiliations

  1. Department of Anesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Center, 1-847 Amanumacho, Omiya-ku, Saitama City, Saitama Prefecture, 330-0834, Japan

    Kyosuke Takahashi, Masamitsu Sanui & Shigehiko Uchino

  2. Department of Anesthesiology and Critical Care Medicine, Kawasaki Municipal Hospital, Kawasaki, Kanagawa, Japan

    Kyosuke Takahashi

  3. Department of Emergency and General Internal Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, Japan

    Norimichi Uenishi

  4. Department of Emergency and Critical Care Medicine, Yokohama City Minato Red Cross Hospital, Yokohama, Kanagawa, Japan

    Naoki Yonezawa & Tetsuhiro Takei

  5. Department of Preventive Services, Kyoto University Graduate School of Medicine, Sakyo, Kyoto, Japan

    Norihiro Nishioka

  6. Division of Nephrology, Department of Internal Medicine, Okinawa Prefectural Chubu Hospital, Uruma, Okinawa, Japan

    Norihiro Nishioka

  7. Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Hirotada Kobayashi

  8. Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada

    Hirotada Kobayashi

  9. Department of Intensive Care Medicine, Kameda Medical Center, Kamogawa, Chiba, Japan

    Hirotada Kobayashi

  10. Department of Emergency Medicine, International University of Health and Welfare Narita Hospital, Narita, Chiba, Japan

    Shunichi Otaka

  11. Department of Emergency Medicine, Kumamoto Red Cross Hospital, Higashi, Kumamoto, Japan

    Shunichi Otaka

  12. Department of Emergency Medicine, Musashino Red Cross Hospital, Musashino, Tokyo, Japan

    Kotaro Yamamoto & Hideto Yasuda

  13. Department of Emergency Medicine, Jichi Medical University Saitama Medical Center, Omiya, Saitama, Japan

    Hideto Yasuda

  14. Department of Medicine, Nerima Hikarigaoka Hospital, Nerima, Tokyo, Japan

    Shintaro Kosaka, Hidehiko Tokunaga & Naoki Fujiwara

  15. Department of Medicine, Taito Municipal Taito Hospital, Taito, Tokyo, Japan

    Naoki Fujiwara

  16. Department of Emergency and Critical Care Medicine, National Hospital Organization Nagoya Medical Center, Nagoya, Aichi, Japan

    Takashiro Kondo

  17. Nanohana Clinic, Ikuno, Osaka, Japan

    Tomoki Ishida

  18. Department of Emergency Medicine, Yodogawa Christian Hospital, Higashi Yodogawa, Osaka, Japan

    Tomoki Ishida

  19. Department of Sports Medicine, Faculty of Medicine, Juntendo University, Bunkyo, Tokyo, Japan

    Takayuki Komatsu

  20. Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima, Tokyo, Japan

    Takayuki Komatsu

  21. Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Sakyo, Kyoto, Japan

    Koji Endo

  22. Department of General Internal Medicine, Tottori Prefectural Central Hospital, Tottori, Tottori, Japan

    Koji Endo

  23. Department of Emergency Medicine, Hyogo Emergency Medical Center, Kobe, Hyogo, Japan

    Taiki Moriyama

  24. Department of Emergency Medicine, Saiseikai Senri Hospital, Suita, Osaka, Japan

    Taiki Moriyama

  25. Department of Emergency Medicine, Hokkaido University Hospital, Sapporo, Hokkaido, Japan

    Takayoshi Oyasu & Mineji Hayakawa

  26. Department of Critical Care Medicine, Kurashiki Central Hospital, Kurashiki, Okayama, Japan

    Atsumi Hoshino

  27. Department of Emergency and Critical Care Medicine, Toyooka Public Hospital, Toyooka, Hyogo, Japan

    Atsumi Hoshino

  28. Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kamigyo, Kyoto, Japan

    Tasuku Matsuyama & Yuki Miyamoto

  29. Department of Anesthesia, Gyoda General Hospital, Gyoda, Saitama, Japan

    Akihiro Yanagisawa

  30. Department of Anesthesiology and Intensive Care, Gunma University Hospital, Maebashi, Gunma, Japan

    Akihiro Yanagisawa

  31. Department of Medicine, Suwa Central Hospital, Chino, Nagano, Japan

    Tadamasa Wakabayashi

  32. Department of Cardiology, Suwa Central Hospital, Chino, Nagano, Japan

    Tadamasa Wakabayashi

  33. Department of Emergency and General Internal Medicine, Rakuwakai Marutamachi Hospital, Nakagyo, Kyoto, Japan

    Takeshi Ueda

  34. Department of Medicine, TMG Muneoka Central Hospital, Shiki, Saitama, Japan

    Tetsuya Komuro

  35. Department of Critical Care, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan

    Tetsuya Komuro

  36. Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan

    Toshiro Sugimoto

  37. Department of Medicine, National Hospital Organization Higashiohmi General Medical Center, Higashiohmi, Shiga, Japan

    Toshiro Sugimoto

  38. Department of Real-World Evidence, Graduate School of Medicine, The University of Tokyo, Bunkyo City, Tokyo, Japan

    Yusuke Sasabuchi

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  1. Kyosuke Takahashi
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Contributions

KT collected and analyzed the data and wrote the manuscript. NU designed the study and collected and analyzed the data. MS designed and directed the project. SU analyzed the data and supervised the manuscript. NY, TT, NN, HK, SO, KY, HY, SK, HT, NF, TK, TI, TK, KE, TM, TO, MH, AH, TM, YM, AY, TW, TU, TK, and TS collected and analyzed the data. YS analyzed the data and performed statistical analysis. All authors reviewed and approved the final version of the manuscript.

Corresponding author

Correspondence to Kyosuke Takahashi.

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The authors declare that they have no conflicts of interest.

Human or animal rights

The study design was approved by the ethics committee of Jichi Medical University (ID: RINS17-023. Registered September 4, 2017) and each institution, with a waiver of informed consent prior to collecting the data. The study was performed in accordance with the Declaration of Helsinki.

Informed consent

Due to the nature of the retrospective study, informed consent was waived, which was also approved by the ethics committee in each institution. Instead, we collected all data completely anonymously and provided opportunities for opting out of the study.

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Takahashi, K., Uenishi, N., Sanui, M. et al. High versus low chloride load in adult hyperglycemic emergencies with acute kidney injury: a multicenter retrospective cohort study. Intern Emerg Med (2024). https://doi.org/10.1007/s11739-024-03556-0

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