Journal article
Association of hyperchloremia and acute kidney injury in pediatric patients with moderate and severe traumatic brain injury
Child's nervous system, v 39(5), pp 1267-1275
01 May 2023
PMID: 36595084
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
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.
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Details
- Title
- Association of hyperchloremia and acute kidney injury in pediatric patients with moderate and severe traumatic brain injury
- Creators
- Mohamed Almuqamam - St. Christopher's Hospital for ChildrenBrian Novi - St. Christopher's Hospital for ChildrenConnie J Rossini - St. Christopher's Hospital for ChildrenAjit Mammen - Drexel UniversityRyan L DeSanti - Drexel University
- Publication Details
- Child's nervous system, v 39(5), pp 1267-1275
- Publisher
- Springer Nature
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Pediatrics
- Web of Science ID
- WOS:000907097500002
- Scopus ID
- 2-s2.0-85145505313
- Other Identifier
- 991021463597404721
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InCites Highlights
Data related to this publication, from InCites Benchmarking & Analytics tool:
- Web of Science research areas
- Clinical Neurology
- Pediatrics
- Surgery