Association of hyperchloremia and acute kidney injury in pediatric patients with moderate and severe traumatic brain injury.

Authors

Mohamed Almuqamam, Department of Pediatrics, Drexel University College of Medicine, St. Christopher's Hospital for Children, Philadelphia, PA, USA.
Brian Novi, Department of Pediatrics, Drexel University College of Medicine, St. Christopher's Hospital for Children, Philadelphia, PA, USA.
Connie J Rossini, Department of Surgery, Drexel University College of Medicine, St. Christopher's Hospital for Children, Philadelphia, PA, USA.
Ajit Mammen, Department of Pediatrics, Drexel University College of Medicine, St. Christopher's Hospital for Children, Philadelphia, PA, USA.
Ryan L DeSanti, Department of Critical Care Medicine, St. Christopher's Hospital for Children, 160 East Erie Avenue, Third Floor Suite, Office A3-20k, Philadelphia, PA, 19143, USA

Document Type

Article

Publication Date

5-2023

Abstract

PURPOSE: 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.

METHODS: 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).

RESULTS: 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).

CONCLUSION: 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.

Publication Title

Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery

Volume

39

Issue

5

First Page

1267

Last Page

1275

Recommended Citation

Almuqamam, M., Novi, B., Rossini, C., Mammen, A., & DeSanti, R. (2023). Association of hyperchloremia and acute kidney injury in pediatric patients with moderate and severe traumatic brain injury.. Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery, 39 (5), 1267-1275. https://doi.org/https://doi.org/10.1007/s00381-022-05810-2