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Hyperglycemic emergencies frequently lead to acute kidney injury (AKI) and require treatment with large amount of intravenous fluids. However, the effects of chloride loading on this population have not yet been investigated. We conducted a multicenter, retrospective, cohort study in 21 acute-care hospitals in Japan. The study included hospitalized adult patients with diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic syndrome (HHS) who had AKI upon arrival. The patients were classified into high and low chloride groups based on the amount of chloride administered within the first 48 h of their arrival. The primary outcome was recovery from AKI; secondary outcome was major adverse kidney events within 30 days (MAKE30), including mortality and prolonged renal failure. A total of 390 patients with AKI, including 268 (69%) with DKA and 122 (31%) with HHS, were included in the study. Using the criteria of Kidney Disease Improving Global Outcomes, the severity of AKI in the patients was Stage 1 (n = 159, 41%), Stage 2 (n = 121, 31%), and Stage 3 (n = 110, 28%). The analysis showed no significant difference between the two groups in recovery from AKI (adjusted hazard ratio, 0.96; 95% CI 0.72-1.28; P = 0.78) and in MAKE30 (adjusted odds ratio, 0.91; 95% CI 0.45-1.76; P = 0.80). Chloride loading with fluid administration had no significant impact on recovery from AKI in patients with hyperglycemic emergencies.Trial Registration This study was registered in the UMIN clinical trial registration system (UMIN000025393, registered December 23, 2016).

Titel:	High versus low chloride load in adult hyperglycemic emergencies with acute kidney injury: a multicenter retrospective cohort study.
Autor/in / Beteiligte Person:	Takahashi, K ; Uenishi, N ; Sanui, M ; Uchino, S ; Yonezawa, N ; Takei, T ; Nishioka, N ; Kobayashi, H ; Otaka, S ; Yamamoto, K ; Yasuda, H ; Kosaka, S ; Tokunaga, H ; Fujiwara, N ; Kondo, T ; Ishida, T ; Komatsu, T ; Endo, K ; Moriyama, T ; Oyasu, T ; Hayakawa, M ; Hoshino, A ; Matsuyama, T ; Miyamoto, Y ; Yanagisawa, A ; Wakabayashi, T ; Ueda, T ; Komuro, T ; Sugimoto, T ; Sasabuchi, Y
Link:	Zum Volltext
Zeitschrift:	Internal and emergency medicine, Jg. 19 (2024-06-01), Heft 4, S. 959-970
Veröffentlichung:	Milan : Springer ; <i>Original Publication</i>: Rome, Italy : CEPI-AIM Group, 2006-, 2024
Medientyp:	academicJournal
ISSN:	1970-9366 (electronic)
DOI:	10.1007/s11739-024-03556-0
Schlagwort:	Humans Retrospective Studies Male Female Middle Aged Aged Japan epidemiology Chlorides blood Chlorides analysis Cohort Studies Adult Hyperglycemia complications Hyperglycemic Hyperosmolar Nonketotic Coma complications Fluid Therapy methods Emergencies Acute Kidney Injury etiology Acute Kidney Injury therapy Acute Kidney Injury physiopathology Diabetic Ketoacidosis complications
Sonstiges:	Nachgewiesen in: MEDLINE Sprachen: English Publication Type: Journal Article; Multicenter Study Language: English [Intern Emerg Med] 2024 Jun; Vol. 19 (4), pp. 959-970. <i>Date of Electronic Publication: </i>2024 Mar 15. MeSH Terms: Acute Kidney Injury* / etiology ; Acute Kidney Injury* / therapy ; Acute Kidney Injury* / physiopathology ; Diabetic Ketoacidosis* / complications ; Humans ; Retrospective Studies ; Male ; Female ; Middle Aged ; Aged ; Japan / epidemiology ; Chlorides / blood ; Chlorides / analysis ; Cohort Studies ; Adult ; Hyperglycemia / complications ; Hyperglycemic Hyperosmolar Nonketotic Coma / complications ; Fluid Therapy / methods ; Emergencies References: Chen J, Zeng H, Ouyang X, Zhu M, Huang Q, Yu W et al (2020) The incidence, risk factors, and long-term outcomes of acute kidney injury in hospitalized diabetic ketoacidosis patients. BMC Nephrol. https://doi.org/10.1186/s12882-020-1709-z. 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(PMID: 10.3892/etm.2017.4292) ; Zhong L, Xie B, Ji XW, Yang XH (2022) The association between albumin corrected anion gap and ICU mortality in acute kidney injury patients requiring continuous renal replacement therapy. Intern Emerg Med 17:2315–2322. https://doi.org/10.1007/s11739-022-03093-8. (PMID: 10.1007/s11739-022-03093-8) Contributed Indexing: Keywords: Acute kidney injury; Diabetes; Diabetic ketoacidosis; Hyperglycemic crisis; Hyperosmolar hyperglycemic state; Hyperosmolar hyperglycemic syndrome Substance Nomenclature: 0 (Chlorides) Entry Date(s): Date Created: 20240315 Date Completed: 20240619 Latest Revision: 20240619 Update Code: 20240619

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High versus low chloride load in adult hyperglycemic emergencies with acute kidney injury: a multicenter retrospective cohort study.