Does Chloride Intake at the Early Phase of Septic Shock Resuscitation Impact on Renal Outcome?. Issue 3 (September 2021)

• Record Type: Journal Article
• Authors: Chapalain, Xavier; Huet, Olivier; Balzer, Thibault; Delbove, Agathe; Martino, Frédéric; Jacquier, Sophie; Egreteau, Pierre-Yves; Darreau, Cédric; Saint-Martin, Marjorie; Lerolle, Nicolas; Aubron, Cécile
• Is Part Of: Shock. Volume 56:Issue 3(2021)
• Publication Date: 2021-09
• Subjects: Acute kidney injury -- electrolytes -- fluid therapy -- septic shock -- sodium chloride; Shock -- Periodicals; Shock -- Periodicals; Choc (Pathologie) -- Périodiques; Shock; Periodicals; 616.0475
• DOI: 10.1097/SHK.0000000000001757
• Languages: English
• ISSNs: 1073-2322

Abstract

ABSTRACT: Introduction: Fluid administration is one of the first lines of treatment for hemodynamic management of sepsis and septic shock. Studies investigating the effects of chloride-rich fluids including normal saline on renal function report controversial findings. Methods: This is a prospective, observational, multicenter study. Patients with septic shock, defined according to Sepsis-2 definition, were eligible. A "high-dose" of chloride was defined as a chloride intake greater than 18 g administrated within the first 48 h of septic shock management. The purpose of this study was to investigate the impact of cumulative chloride infusion within the first 48 h of septic shock resuscitation on acute kidney injury (AKI). Results: Two hundred thirty-nine patients with septic shock were included. Patients who received a "high-dose" of chloride had significantly higher Sequential Organ Failure Assessment score at the time of enrolment ( P < 0.001). Cumulative chloride load was higher in patients requiring renal replacement therapy (RRT) (31.1 vs. 25.2 g/48 h; P < 0.005). Propensity score-weighted regression did not find any association between "high-dose" of chloride and AKI requiring RRT (OR: 0.97 [0.88–1.1]; P = 0.69). There was no association between "high-dose" of chloride and worsening kidney function at H48 (OR: 0.94 [0.83–1.1]; P = 0.42). There was also no association between "high-dose" of chloride and ICU length of stay ( P = 0.61), 28-day mortality ( P = 0.83), or hospital mortality ( P = 0.89). Conclusion: At the early stage of resuscitation of critically ill patients with septic shock, administration of "high-dose" of chloride (> 18 g/48 h) was not associated with renal prognosis. Abstract : Supplemental Digital Content is available in the text