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Abstract: FR-PO203

Serum Chloride Associates with CKD Progression

Session Information

Category: CKD (Non-Dialysis)

  • 1901 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention


  • Khatri, Minesh, NYU Winthrop, Mineola, New York, United States
  • Zitovsky, Josh P., NYU Winthrop Hospital, Mineola, New York, United States
  • Fazzari, Melissa J., NYU Winthrop Hospital, Mineola, New York, United States
  • Grant, Candace D., NYU Winthrop Hospital, Mineola, New York, United States

Chloride is the predominant extracellular anion in the body, serving important functions including maintenance of electroneutrality, modulation of renin secretion, and regulation of renal sodium transport. Limited data suggest it may predict mortality in heart failure, chronic kidney disease (CKD), and pulmonary arterial hypertension. Recent randomized trials in hospitalized patients have also shown that administration of crystalloid intravenous fluids with lower chloride concentration may have better renal outcomes than fluids with higher chloride concentration. However, chloride has not been studied longitudinally for CKD progression.


536 subjects with predominantly stage 3 and 4 CKD were recruited into a prospective cohort study from a nephrology clinic at a single academic medical center. Renal function was re-assessed longitudinally. Logistic and Cox regression models were created for outcomes of upper quartile of annualized estimated glomerular filtration rate (eGFR) decline and > 30% decline in eGFR, respectively. Baseline chloride was modeled continuously as an independent variable, and models were adjusted for potential confounders including co-morbidities, proteinuria, and relevant serum labs and medications.


Median follow-up time was 1.7 years. At baseline, median age was 73, 62% were male, 52% diabetic, 91% hypertensive, and median eGFR was 36 mL/min. Median serum chloride at baseline was 105 mEq/L (interquartile range 102-107 mEq/L). In fully adjusted models, higher serum chloride significantly associated with greater likelihood of upper quartile of annualized eGFR decline (OR 1.09 per 1 mEq/L increase in serum chloride, p = 0.031), and greater hazard of > 30% eGFR decline (HR 1.06 per 1 mEq/L increase in serum chloride, p = 0.036).


In this cohort of CKD patients, higher serum chloride levels associated with increased risk of eGFR decline. Chloride may be a useful, readily available biomarker to aid in predicting CKD progression. Further studies are needed to determine if there is causality, and if so to elucidate pathophysiology and delineate possible treatment strategies.


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