Kidney Week

Abstract: FR-PO054

Chloride Variation as an Independent Risk Factor for AKI Development and In-Hospital Mortality in Patients with Rhabdomyolysis

Session Information

• AKI: Epidemiology, Risk Factors, and Prevention - 2
  October 25, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

• 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

• Araujo, Lucas, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, São Paulo, Brazil

Lucas Araujo

• Spada, Tania de Carvalho, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, São Paulo, Brazil

Tania de Carvalho Spada, MD

• Silva, Bruna Florentino Diniz, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, São Paulo, Brazil

Bruna Florentino Diniz Silva

• Ribeiro, Heitor S., Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, São Paulo, Brazil

Heitor S. Ribeiro, PhD

• Andrade, Lucia, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, São Paulo, Brazil

Lucia Andrade, MD, PhD

• Burdmann, Emmanuel A., Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, São Paulo, Brazil

Emmanuel A. Burdmann, MD, PhD

• Vieira Jr., Jose M., Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, São Paulo, Brazil

Jose M. Vieira Jr., MD, PhD

Background

Rhabdomyolysis (RB) is considered as an important cause for acute kidney injury (AKI) and mortality. Studies have suggested that acidosis is a risk factor for AKI. We alternatively hypothesized that serum chloride variation (SCV) might be associated with AKI and mortality in RB patients.

Methods

We studied a retrospective cohort of RB (>5x reference values of CPK) patients admitted in a tertiary hospital during a year. Demographic, clinical and laboratorial data were assessed and a regression analysis (RA) was performed in order to identify the independent variables associated with AKI and 28d mortality, including SCV.

Results

We included 291 patients admitted with RB due to diverse causes, from which 67% developed AKI. AKI patients were older, had more comorbidities and were sicker during admission (shock 35 vs 13%; p < 0.0001, mechanical ventilation, MV 49 vs 29%; p= 0.0015; sepsis 11 vs 3%; p=0.03). Peak CPK levels were higher in the AKI group (4218 IQR 2316-8968 vs 3221 IQR 1940-6206 U/L; p=0.04). Serum bicarbonate (SBic) and chloride did not differ between AKI and non-AKI at admission (21.0 IQR 18-24 vs 21.5 IQR 20-24 mEq/L, p=0.3; and 107 IQR 102-111 vs 107 IQR 113-111 mEq/L, p=0.5, respectively). During hospitalization, SCV was higher in the AKI group (2 IQR 0-10 vs 0 IQR 0-10 mEq/L, p=0.0003), and SBic was lower (18 IQR 14-21 vs 21 IQR 19-24 mEq/L, p< 0.0001). After RA, SCV remained as an independent variable associated with AKI (OR 1.09 CI 1.01-1.16, p=0.020), along with baseline hypertension (p=0.024) and SBic (p<0.001). AKI patients had higher mortality (39 vs 3.5%, p<0.0001) and RA showed that SCV was associated with mortality in the entire cohort (OR 1.082 CI 1.006-1.163, p=0.035), along with increased age, use of MV, AKI, use of renal replacement therapy, trauma and higher serum lactate.

Conclusion

Higher serum chloride variation was an independent risk factor for AKI and death in hospitalized patients with RB.