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Abstract: FR-PO047

Hyperchloremia Is Associated with AKI in Pediatric Patients with Septic Shock

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials


  • Stenson, Erin K., Cincinnati Children''s Hospital Medical Center, Cincinnati, Ohio, United States
  • Cvijanovich, Natalie Z., UCSF Benioff Childrens Hospital, Oakland, California, United States
  • Thomas, Neal J., Penn State, Hershey, Pennsylvania, United States
  • Bigham, Michael T., Akron Children''s Hospital, Akron, Ohio, United States
  • Fitzgerald, Julie C., Children''s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
  • Quasney, Michael W., University of Michigan, Ann Arbor, Michigan, United States
  • Hall, Mark W., Nationwide Children''s Hospital, Columbus, Ohio, United States
  • Gedeit, Rainer, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
  • Freishtat, Robert Jeffrey, Children''s National Health System, Washington, District of Columbia, United States
  • Nowak, Jeffrey E., Children''s Respiratory and Critical Care Services, P.A., Minneapolis, Minnesota, United States
  • Lutfi, Riad, Riley Hospital for Children, Indianapolis, Indiana, United States
  • Gertz, Shira J., Saint Barnabas Medical Center , Livingston, New Jersey, United States
  • Grunwell, Jocelyn R., Emory University/Children?s Healthcare of Atlanta, Atlanta, Georgia, United States
  • Wong, Hector R., Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Jain, Parag N., Texas Children''s Hospital, Houston, Texas, United States

Hyperchloremia is associated with increased mortality in pediatric septic shock patients, and associated with increased rate of acute kidney injury (AKI) in adults. It is unknown whether hyperchloremia is associated with AKI in pediatric patients.


We tested the hypothesis that hyperchloremia is associated with increased rates of severe AKI in pediatric patients with septic shock. We performed a retrospective analysis of a pediatric septic shock database that included 619 children with septic shock from 29 PICUs in the U.S. We considered the minimum, maximum, and mean chloride values as separate hyperchloremia variables within the first 7 days of PICU admission. We considered hyperchloremia as a dichotomized variable defined a priori as a serum concentration ≥110mmol/L. We used multivariable logistic regression to determine the association between these hyperchloremia variables and outcomes, after adjusting for illness severity and age. Our primary outcome variable was day 3 AKI, defined as KDIGO stage 2 or 3.


There were 125 subjects with AKI and 494 subjects with no AKI. Subjects with AKI were younger (1.7 years; IQR 0.7-5.4 v. 3.5 years; IQR 1.3-7.1; p <0.001) and had higher PRISM-III scores (15; IQR 9-24 v. 11; IQR 7-16; p <0.001). There were 42 subjects with a minimum chloride ≥110mmol/L, 117 subjects with a mean chloride ≥110mmol/L, and 359 subjects with a maximum chloride ≥110mmol/L. A minimum chloride ≥110mmol/L was associated with increased odds of AKI (odds ratio, 2.4; 95% CI, 1.2-4.9; p = 0.014). A mean chloride ≥110mmol/L was associated with increased odds of AKI (odds ratio, 1.8; 95% CI, 1.1-2.9; p = 0.014).


Hyperchloremia is independently associated with severe AKI in pediatric patients with septic shock. Further evaluation of the optimal fluid to be used in resuscitation of these patients is warranted.

VariableOdds Ratio95% CIp value
Minimum Cl ≥1102.41.2-4.90.014
Mean Cl ≥1101.81.1-2.90.014


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