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Chloride-Restriction Lowers Rates of Kidney Injury in ICU

Last Updated: October 16, 2012.

A chloride-restrictive intravenous fluid strategy in the intensive care unit is associated with significantly decreased incidence of acute kidney injury and use of renal replacement therapy, according to a pilot study published in the Oct. 17 issue of the Journal of the American Medical Association.

TUESDAY, Oct. 16 (HealthDay News) -- A chloride-restrictive intravenous fluid strategy in the intensive care unit (ICU) is associated with significantly decreased incidence of acute kidney injury (AKI) and use of renal replacement therapy (RRT), according to a pilot study published in the Oct. 17 issue of the Journal of the American Medical Association.

Nor'azim Mohd Yunos, M.D., from the Monash University Sunway Campus in Malaysia, and colleagues conducted a prospective, open-label, sequential period pilot study to assess the link between a chloride-restrictive intravenous fluid strategy and AKI in critically ill patients. During the control period, 760 patients admitted consecutively to the ICU were given standard intravenous fluids (chloride-liberal). These patients were compared with 773 patients admitted consecutively during the intervention period, one year later, who were given a lactated solution, a balanced solution (Plasma-Lyte 148), and chloride-poor 20 percent albumin.

The researchers found that the increase in mean serum creatinine level while in the ICU was 22.6 µmol/L during the control period versus 14.8 µmol/L for the intervention period (P = 0.03). The incidence of injury and failure class of RIFLE (risk, injury, failure, loss, end-stage)-defined AKI was 14 percent in the control group versus 8.4 percent in the intervention group (P < 0.001), and the use of RRT was 10 versus 6.3 percent (P = 0.005). These associations remained significant even after adjustment for other variables.

"The implementation of a chloride-restrictive strategy in a tertiary ICU was associated with a significant decrease in the incidence of AKI and use of RRT," the authors write.

One author disclosed financial ties to the pharmaceutical industry.

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