Association of hyperchloremia and acute kidney injury in pediatric patients with moderate and severe traumatic brain injury.
Acute kidney injury
Hyperchloremia
Pediatric
Traumatic brain injury
Journal
Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery
ISSN: 1433-0350
Titre abrégé: Childs Nerv Syst
Pays: Germany
ID NLM: 8503227
Informations de publication
Date de publication:
05 2023
05 2023
Historique:
received:
06
09
2022
accepted:
14
12
2022
medline:
10
5
2023
pubmed:
4
1
2023
entrez:
3
1
2023
Statut:
ppublish
Résumé
Acute kidney injury (AKI) is an established complication of adult traumatic brain injury (TBI) and known risk factor for mortality. Evidence demonstrates an association between hyperchloremia and AKI in critically ill adults but studies in children are scarce. Given frequent use of hypertonic saline in the management of pediatric TBI, we believe the incidence of hyperchloremia will be high and hypothesize that it will be associated with development of AKI. Single-center retrospective cohort study was completed at an urban, level 1 pediatric trauma center. Children > 40 weeks corrected gestational age and < 21 years of age with moderate or severe TBI (presenting GCS < 13) admitted between January 2016 and December 2021 were included. Primary study outcome was presence of AKI (defined by pediatric Kidney Disease: Improving Global Outcomes criteria) within 7 days of hospitalization and compared between patients with and without hyperchloremia (serum chloride ≥ 110 mEq/L). Fifty-two children were included. Mean age was 5.75 (S.D. 5.4) years; 60% were male (31/52); and mean presenting GCS was 6 (S.D. 2.9). Thirty-seven patients (71%) developed hyperchloremia with a mean peak chloride of 125 (S.D. 12.0) mEq/L and mean difference between peak and presenting chloride of 16 (S.D. 12.7) mEq/L. Twenty-three patients (44%) developed AKI; of those with hyperchloremia, 62% (23/37) developed AKI, while among those without hyperchloremia, 0% (0/15) developed AKI (difference 62%, 95% CI 42-82%, p < 0.001). Attributable risk of hyperchloremia leading to AKI was 62.2 (95% CI 46.5-77.8, p = 0.0015). Hyperchloremia is common in the management of pediatric TBI and is associated with development of AKI. Risk appears to be associated with both the height of serum chloride and duration of hyperchloremia.
Identifiants
pubmed: 36595084
doi: 10.1007/s00381-022-05810-2
pii: 10.1007/s00381-022-05810-2
doi:
Substances chimiques
Chlorides
0
Saline Solution, Hypertonic
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1267-1275Informations de copyright
© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
Références
CDC (2022) Traumatic brain injury & concussion. In: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Available via https://www.cdc.gov/traumaticbraininjury/index.html
Wang R, Zhang J, Xu J, He M, Xu J (2021) Incidence and burden of acute kidney injury among traumatic brain-injury patients. Risk Manag Healthcare Policy 14:4571–4580. https://doi.org/10.2147/RMHP.S335150
doi: 10.2147/RMHP.S335150
Lim HB, Smith M (2007) Systemic complications after head injury: a clinical review. Anaesthesia 62:474–482. https://doi.org/10.1111/j.1365-2044.2007.04998.x
doi: 10.1111/j.1365-2044.2007.04998.x
pubmed: 17448059
Ahmed A, Vairavan S, Akhoundi A et al (2015) Development and validation of electronic surveillance tool for acute kidney injury: a retrospective analysis. J Crit Care 30:988–993. https://doi.org/10.1016/j.jcrc.2015.05.007
doi: 10.1016/j.jcrc.2015.05.007
pubmed: 26070247
Corral L, Javierre CF, Ventura JL, Marcos P, Herrero JI, Mañez R (2012) Impact of non-neurological complications in severe traumatic brain injury outcome. Crit Care 16:R44. https://doi.org/10.1186/cc11243
doi: 10.1186/cc11243
pubmed: 22410278
pmcid: 3681369
Wang RR, He M, Ou XF, Xie XQ, Kang Y (2020) The predictive value of serum uric acid on acute kidney injury following traumatic brain injury. Biomed Res Int 2020:2874369. https://doi.org/10.1155/2020/2874369
doi: 10.1155/2020/2874369
pubmed: 32934958
pmcid: 7479452
Wang R, He M, Ou XF, Xie XQ, Kang Y (2020) Serum procalcitonin level predicts acute kidney injury after traumatic brain injury. World Neurosurg 141:e112-117. https://doi.org/10.1016/j.wneu.2020.04.245
doi: 10.1016/j.wneu.2020.04.245
pubmed: 32438001
Wang RR, He M, Gui X, Kang Y (2021) A nomogram based on serum cystatin C for predicting acute kidney injury in patients with traumatic brain injury. Ren Fail 43:206–215. https://doi.org/10.1080/0886022X.2021.1871919
doi: 10.1080/0886022X.2021.1871919
pubmed: 33478333
pmcid: 7833079
Ditch KL, Flahive JM, West AM, Osgood ML, Muehlschlegel S (2020) Hyperchloremia, not concomitant hypernatremia, independently predicts early mortality in critically ill moderate–severe traumatic brain injury patients. Neurocrit Care 33:533–541. https://doi.org/10.1007/s12028-020-00928-0
doi: 10.1007/s12028-020-00928-0
pubmed: 32043263
Wang RR, He M, Ou XF, Xie XQ, Kang Y (2020) The predictive value of RDW in AKI and mortality in patients with traumatic brain injury. J Clin Lab Anal 34:e23373. https://doi.org/10.1002/jcla.23373
doi: 10.1002/jcla.23373
pubmed: 32844458
pmcid: 7521248
Zygun D (2005) Non-neurological organ dysfunction in neurocritical care: impact on outcome and etiological considerations. Curr Opin Crit Care 11:139–143. https://doi.org/10.1097/01.ccx.0000155356.86241.c0
doi: 10.1097/01.ccx.0000155356.86241.c0
pubmed: 15758594
Moore EM, Bellomo R, Nichol A, Harley N, MacIsaac C, Cooper DJ (2010) The incidence of acute kidney injury in patients with traumatic brain injury. Ren Fail 32:1060–1065. https://doi.org/10.3109/0886022X.2010.510234
doi: 10.3109/0886022X.2010.510234
pubmed: 20863210
Li S, Krawczeski CD, Zappitelli M et al (2011) Incidence, risk factors, and outcomes of acute kidney injury after pediatric cardiac surgery: a prospective multicenter study. Crit Care Med 39:1493–1499. https://doi.org/10.1097/CCM.0b013e31821201d3
doi: 10.1097/CCM.0b013e31821201d3
pubmed: 21336114
pmcid: 3286600
Goyal K, Hazarika A, Khandelwal A et al (2018) Non-neurological complications after traumatic brain injury: a prospective observational study. Indian J Crit Care Med 22:632–638. https://doi.org/10.4103/ijccm.IJCCM_156_18
doi: 10.4103/ijccm.IJCCM_156_18
pubmed: 30294128
pmcid: 6161576
Robba C, Banzato E, Rebora P et al (2021) Acute kidney injury in traumatic brain injury patients: results from the collaborative European neurotrauma effectiveness research in traumatic brain injury study. Crit Care Med 49:112–126. https://doi.org/10.1097/CCM.0000000000004673
doi: 10.1097/CCM.0000000000004673
pubmed: 33060506
Stenson EK, Cvijanovich NZ, Allen GL et al (2018) Hyperchloremia is associated with acute kidney injury in pediatric patients with septic shock. Intensive Care Med 44:2004–2005. https://doi.org/10.1007/s00134-018-5368-5
doi: 10.1007/s00134-018-5368-5
pubmed: 30324289
Kimura S, Iwasaki T, Shimizu K et al (2019) Hyperchloremia is not an independent risk factor for postoperative acute kidney injury in pediatric cardiac patients. J Cardiothorac Vasc Anesth 33:1939–1945. https://doi.org/10.1053/j.jvca.2018.12.009
doi: 10.1053/j.jvca.2018.12.009
pubmed: 30638924
Leteurtre S, Duhamel A, Salleron J et al (2013) PELOD-2: an update of the Pediatric logistic organ dysfunction score. Crit Care Med 41:1761–1773. https://doi.org/10.1097/CCM.0b013e31828a2bbd
doi: 10.1097/CCM.0b013e31828a2bbd
pubmed: 23685639
Fiser DH (1992) Assessing the outcome of pediatric intensive care. J Pediatr 121:68–74. https://doi.org/10.1016/s0022-3476(05)82544-2
doi: 10.1016/s0022-3476(05)82544-2
pubmed: 1625096
Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO (2012) Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease (2013). Kidney inter 3:1–150. https://doi.org/10.1038/kisup.2012.73
doi: 10.1038/kisup.2012.73
Schwartz GJ, Muñoz A, Schneider MF et al (2009) New equations to estimate GFR in children with CKD. J Am Soc Nephrol 20:629–637. https://doi.org/10.1681/ASN.2008030287
doi: 10.1681/ASN.2008030287
pubmed: 19158356
pmcid: 2653687
Gist KM, Selewski DT, Brinton J, Menon S, Goldstein SL, Basu RK (2020) Assessment of the independent and synergistic effects of fluid overload and acute kidney injury on outcomes of critically ill children. Pediatr Crit Care Med 21:170–177. https://doi.org/10.1097/PCC.0000000000002107
doi: 10.1097/PCC.0000000000002107
pubmed: 31568240
pmcid: 7007847
Gaies MG, Gurney JG, Yen AH et al (2010) Vasoactive-inotropic score as a predictor of morbidity and mortality in infants after cardiopulmonary bypass. Pediatr Crit Care Med 11:234–238. https://doi.org/10.1097/PCC.0b013e3181b806fc
doi: 10.1097/PCC.0b013e3181b806fc
pubmed: 19794327
Holliday MA, Segar WE (1957) The maintenance need for water in parenteral fluid therapy. Pediatrics. https://doi.org/10.1542/peds.19.5.8232
von Elm E, Altman DG, Egger M et al (2008) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 61:344–349. https://doi.org/10.1016/j.jclinepi.2007.11.008
doi: 10.1016/j.jclinepi.2007.11.008
Cuesta JM, Singer M (2012) The stress response and critical illness: a review. Crit Care Med 40:3283–3289. https://doi.org/10.1097/CCM.0b013e31826567eb
doi: 10.1097/CCM.0b013e31826567eb
pubmed: 22975887
Sigmon J, May CC, Bryant A, Humanez J, Singh V (2020) Assessment of acute kidney injury in neurologically injured patients receiving hypertonic sodium chloride: does chloride load matter? Ann Pharmacother 54:541–546. https://doi.org/10.1177/1060028019891986
doi: 10.1177/1060028019891986
pubmed: 31791136
Yamane DP, Maghami S, Graham A, Vaziri K, Davison D (2022) Association of hyperchloremia and acute kidney injury in patients with traumatic brain injury. J Intensive Care Med 37:128–133. https://doi.org/10.1177/0885066620978735
doi: 10.1177/0885066620978735
pubmed: 33283597
Wilcox CS (1983) Regulation of renal blood flow by plasma chloride. J Clin Invest 71:726–735. https://doi.org/10.1172/jci110820
doi: 10.1172/jci110820
pubmed: 6826732
pmcid: 436923
Rein JL, Coca SG (2019) “I don’t get no respect”: the role of chloride in acute kidney injury. Am J Physiol Renal Physiol 316:F587-605. https://doi.org/10.1152/ajprenal.00130.2018
doi: 10.1152/ajprenal.00130.2018
pubmed: 30539650
Kochanek PM, Tasker RC, Carney N et al (2019) Guidelines for the management of pediatric severe traumatic brain injury, Third Edition: Update of the Brain Trauma Foundation Guidelines. Pediatr Crit Care Med 20:S1-82. https://doi.org/10.1097/PCC.0000000000001735
doi: 10.1097/PCC.0000000000001735
pubmed: 30829890
Kofke WA (1993) Mannitol: potential for rebound intracranial hypertension? J Neurosurg Anesthesiol 5:1–3. https://doi.org/10.1097/00008506-199301000-00001
doi: 10.1097/00008506-199301000-00001
pubmed: 8431664
Kochanek PM, Adelson PD, Rosario BL et al (2022) Comparison of intracranial pressure measurements before and after hypertonic saline or mannitol treatment in children with severe traumatic brain injury. JAMA Netw Open 5:e220891. https://doi.org/10.1001/jamanetworkopen.2022.0891
doi: 10.1001/jamanetworkopen.2022.0891
pubmed: 35267036
pmcid: 8914575
Qureshi AI, Suarez JI (2000) Use of hypertonic saline solutions in treatment of cerebral edema and intracranial hypertension. Crit Care Med 28:3301–3313. https://doi.org/10.1097/00003246-200009000-00032
doi: 10.1097/00003246-200009000-00032
pubmed: 11008996
Gonda DD, Meltzer HS, Crawford JR et al (2013) Complications associated with prolonged hypertonic saline therapy in children with elevated intracranial pressure. Pediatr Crit Care Med 14:610–620. https://doi.org/10.1097/PCC.0b013e318291772b
doi: 10.1097/PCC.0b013e318291772b
pubmed: 23823197
Webster DL, Fei L, Falcone RA, Kaplan JM (2015) Higher-volume hypertonic saline and increased thrombotic risk in pediatric traumatic brain injury. J Crit Care 30:1267–1271. https://doi.org/10.1016/j.jcrc.2015.07.022
doi: 10.1016/j.jcrc.2015.07.022
pubmed: 26307005
Peterson B, Khanna S, Fisher B, Marshall L (2000) Prolonged hypernatremia controls elevated intracranial pressure in head-injured pediatric patients. Crit Care Med 28:1136–1143. https://doi.org/10.1097/00003246-200004000-00037
doi: 10.1097/00003246-200004000-00037
pubmed: 10809295
Simma B, Burger R, Falk M, Sacher P, Fanconi S (1998) A prospective, randomized, and controlled study of fluid management in children with severe head injury: lactated Ringer’s solution versus hypertonic saline. Crit Care Med 26:1265–1270. https://doi.org/10.1097/00003246-199807000-00032
doi: 10.1097/00003246-199807000-00032
pubmed: 9671379
Qureshi AI, Suarez JI, Bhardwaj A et al (1998) Use of hypertonic (3%) saline/acetate infusion in the treatment of cerebral edema: effect on intracranial pressure and lateral displacement of the brain. Crit Care Med 26:440–446. https://doi.org/10.1097/00003246-199803000-00011
doi: 10.1097/00003246-199803000-00011
pubmed: 9504569
Wells DL, Swanson JM, Wood GC et al (2012) The relationship between serum sodium and intracranial pressure when using hypertonic saline to target mild hypernatremia in patients with head trauma. Crit Care 16:R193. https://doi.org/10.1186/cc11678
doi: 10.1186/cc11678
pubmed: 23068293
pmcid: 3682295
Roquilly A, Moyer JD, Huet O et al (2021) Effect of continuous infusion of hypertonic saline vs standard care on 6-month neurological outcomes in patients with traumatic brain injury: the COBI randomized clinical trial. JAMA 325:2056–2066. https://doi.org/10.1001/jama.2021.5561
doi: 10.1001/jama.2021.5561
pubmed: 34032829
Barhight MF, Brinton JT, Soranno DE, Faubel S, Mourani PM, Gist KM (2020) Effects of hyperchloremia on renal recovery in critically ill children with acute kidney injury. Pediatr Nephrol 35:1331–1339. https://doi.org/10.1007/s00467-020-04513-7
doi: 10.1007/s00467-020-04513-7
pubmed: 32152726
Holden DN, Yung FH, Entezami P (2021) Hypertonic saline buffered with sodium acetate for intracranial pressure management. Clin Neurol Neurosurg 201:106435. https://doi.org/10.1016/j.clineuro.2020.106435
doi: 10.1016/j.clineuro.2020.106435
pubmed: 33373834
Sadan O, Singbartl K, Kraft J et al (2022) Low-chloride- versus high-chloride-containing hypertonic solution for the treatment of subarachnoid hemorrhage-related complications: the ACETatE (A low ChloriE hyperTonic solution for brain Edema) randomized trial. J Intensive Care 8:32. https://doi.org/10.1186/s40560-020-00449-0
doi: 10.1186/s40560-020-00449-0
Huang Z-Y, Liu Y, Huang H-F, et al (2022) Acute kidney injury in traumatic brain injury intensive care unit patients. World J Clin Cases 10:2751–2763. https://doi.org/10.12998/wjcc.v10.i9.2751
Kimmoun A, Ducrocq N, Sennoun N et al (2014) Efficient extra- and intracellular alkalinization improves cardiovascular functions in severe lactic acidosis induced by hemorrhagic shock. Anesthesiology 120:926–934. https://doi.org/10.1097/ALN.0000000000000077
doi: 10.1097/ALN.0000000000000077
pubmed: 24263236
U.S. National Library of Medicine (2020) In: ClinicalTrials.gov. Available via https://clinicaltrials.gov