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Acute kidney injury

Restriction of intravenous chloride intake may reduce the incidence of AKI in critically ill patients

Nature Reviews Nephrology volume 8, page 679 (2012)Cite this article

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Some intravenous fluids contain supraphysiological levels of chloride, despite experimental evidence indicating a link between chloride administration and decreased renal function. A new study, published in The Journal of the American Medical Association, now reports associations between use of chloride-restrictive intravenous solutions and reduced incidence of acute kidney injury (AKI) and need for renal replacement therapy in critically ill patients.

Intravenous fluid therapy is widely used in critical care medicine and many types of fluid exist. Previous studies have demonstrated that excessive chloride administration can lead to adverse effects, including metabolic acidosis, renal vasoconstriction and decreased glomerular filtration rate. Moreover, critically ill patients are known to be at high risk of developing AKI. These findings led Nor'azim Mohd Yunos and colleagues to investigate whether a chloride-restrictive intravenous fluid strategy in critically ill patients might be associated with a decreased incidence and severity of AKI compared with a chloride-liberal approach. “Saline is ubiquitously used and yet physiologically irrational”, explains corresponding author, Rinaldo Bellomo. “I wanted to see if removing the chloride was feasible, safe, and maybe beneficial.”

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References

ORIGINAL RESEARCH PAPER

  1. Yunos, N. M. et al. Association between a chloride-liberal vs chloride-restrictive intravenous fluid administration strategy and kidney injury in critically ill adults. JAMA 308, 1566–1572 (2012)

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FURTHER READING

  1. Waikar, S. S. & Winkelmayer, W. C. Saving the kidneys by sparing intravenous chloride? JAMA 308, 1583–1585 (2012)

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Authors
  1. Susan J. Allison
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Allison, S. Restriction of intravenous chloride intake may reduce the incidence of AKI in critically ill patients. Nat Rev Nephrol 8, 679 (2012). https://doi.org/10.1038/nrneph.2012.221

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