Hisham, Wan Mohd Hafidz Wan
(2019)
Incidence and factors associated with acute kidney injury (AKI) in hyperchloremic critically III adult patients.
Masters thesis, Universiti Sains Malaysia.
Abstract
Hyperchloremia is still the least looked at electrolytes imbalance in ICU despite a few
studies in the last decade has proven its association with AKI. This study is aimed to
report on the incidence and factors associated with AKI in hyperchloremic critically ill
adult patients.
Methods
In this retrospective cohort study held in a tertiary hospital, hyperchloremic patients
aged 18-65 years old on admission were included. Development of AKI using AKIN
criteria within the next 48 hours was marked as the primary outcome and factors
associated with it were analysed.
Results
248 (11.7%) of the patients admitted during the study were hyperchloremic on
admission. Out of this, 84 (34%) patients developed AKI. Age 56-65 years [OR=2.598
(1.126-5.995); p=0.025], SAPS II score [OR=1.04 (1.02-1.06); p<0.001], respiratory
failure [OR=2.516 (1.064-5.947); p=0.036], cardiovascular failure [OR=2.239 (1.083-4.626); p=0.030], severe hyperchloremia[OR=2.045 (1.176-3.557); p=0.011],
severe acidemia [OR=2.733 (1.269-5.886); p=0.010] and severe metabolic
acidosis[OR=2.003 (1.010-3.972);p=0.047] were found to be associated with AKI. After
adjusting to confounding factors, SAPS II score (adjusted OR, 1.032 [1.003-1.062];
p=0.028) and age 56-65 years (adjusted OR, 2.506 [1.024-6.135]; p=0.044) were found
to be predictive of AKI.
Conclusions
One-third of hyperchloremic patients developed AKI after 48 hours of ICU admission.
SAPS II score and age group 55-65 years are proven to be predictive factors of later
development of AKI. SAPS II score is a useful tool in predicting AKI in hyperchloremic
patients.
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