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Kidney Week

Abstract: PO0060

Impact of Chloride-Rich Crystalloids on Sepsis-Associated Community-Acquired AKI Recovery in Critically Ill Patients

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Tehranian, Shahrzad, Department of Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, United States
  • Shawwa, Khaled, Department of Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, United States
  • Barreto, Erin F., Department of Pharmacy, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, United States
  • Clements, Casey M., Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, United States
  • Kashani, Kianoush, Department of Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, United States
Background

The use of chloride-rich crystalloids for resuscitation is associated with developing acute kidney injury (AKI). We aimed to explore the impact of resuscitation with chloride-rich crystalloids compared to balanced crystalloids on the recovery of kidney function in patients presenting with established sepsis-associated community-acquired AKI (SACA-AKI).

Methods

This was a single-center, historical cohort study of patients admitted to the intensive care unit (ICU) who presented to the emergency department (ED) with SACA-AKI at Mayo Clinic, Rochester, MN, from January 2011 to April 2018. We divided the cohort into two groups based on the primary type of crystalloids received in the ED and the first 48-hours of ICU. The first group received primarily normal saline with <20% balanced solutions, and the second group received at least ≥20% balanced crystalloids during the initial volume resuscitation.

Results

We included 736 patients who were resuscitated with crystalloids after SACA-AKI diagnosis (mean age 64±16, n = 463 (63%) males). There were 286 (39%) patients in the second group, found to have higher positive fluid balance during the first 48-hours of admission compared to the first group [median 5.7 (IQR: 3.6; 8) vs. 3.8 (IQR: 2.1; 6.1) L, P < .001]. By multivariate logistic regression, the patients in the second group had a higher rate of kidney function recovery after adjustments for known recovery risk factors (OR 1.4; 95% CI: 1.04-2, P = .027).

Conclusion

The use of balanced crystalloids during the initial resuscitation is associated with higher odds of kidney function recovery in patients with SACA-AKI.

Funding

  • Other NIH Support