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Abstract: FR-PO274

Serum Chloride and All-Cause Mortality in CKD

Session Information

Category: Fluid and Electrolytes

  • 902 Fluid and Electrolytes: Clinical


  • Navaneethan, Sankar D., Baylor College of Medicine, Sugar Land, Texas, United States
  • Winkelmayer, Wolfgang C., Baylor College of Medicine, Sugar Land, Texas, United States
  • Arrigain, Susana, Cleveland Clinic, Cleveland, Ohio, United States
  • Nally, Joseph V., Cleveland Clinic, Cleveland, Ohio, United States

We studied the associations of serum chloride with all-cause mortality in non-dialysis dependent CKD.


We included 62,643 patients with eGFR 15-59 ml/min/1.73 m2 (twice 90 days apart) and had serum chloride measured using the same assay in a single health care system in this analysis. Cox proportional hazards model (including time-dependent) were used to study the associations between hypochloremia (<98 mmol/l, n=5246) and hyperchloremia (>110 mmol/l, n=702) with all-cause mortality while adjusting for demographics, comorbid conditions including heart failure, use of diuretics and kidney function.


During a median follow-up of 3.8 years, 18,181 patients died. In the Cox proportional hazards model using baseline serum chloride levels, hypochloremia (but not hyperchloremia) was associated with higher risk of death. Analysis of chloride as continuous measure yielded similar results. Restricting the analysis to those with normal serum sodium (n=59,964) yielded similar results. In the model with time dependent repeated measures of serum chloride, both hypochloremia (HR 2.54, 95% CI 1.44, 2.65) and hyperchloremia (HR 1.39, 95% 1.24, 1.55) were associated with higher risk of death. Presence or absence of CHF didn't modify the observed associations.


Among non-dialysis dependent CKD population, hypochloremia is associated with higher risk of death. Further studies examining the potential mechanisms for the observed associations are warranted.