ArticlePediatric nephrology (Berlin, Germany)2018
Hyperchloremia is independently associated with mortality in critically ill children who ultimately require continuous renal replacement therapy.
Article in Pediatric nephrology (Berlin, Germany), 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06050525 (Incidence of Acute Kidney Injury and Risk Factors in Newborns With Congenital Diaphragmatic Hernia), which is not on this map. Cited by 19 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Incidence of Acute Kidney Injury and Risk Factors in Newborns With Congenital Diaphragmatic Hernia
Who cites it
19 citing papers in PubMed, 35 citations in OpenAlex.
- Incidence of and risk factors for acute kidney injury in neonates with congenital diaphragmatic hernia.European journal of pediatrics · 2025Article
- A balancing act: drifting away from the reflexive use of "ab"normal saline.Pediatric nephrology (Berlin, Germany) · 2024Review
- Fluid assessment, fluid balance, and fluid overload in sick children: a report from the Pediatric Acute Disease Quality Initiative (ADQI) conference.Pediatric nephrology (Berlin, Germany) · 2024Article
- Urinary Chloride Excretion Postcardiopulmonary Bypass in Pediatric Patients-A Pilot Study.Journal of pediatric intensive care · 2024Article
- Hyperchloremia and acute kidney injury: chicken or the egg?Pediatric nephrology (Berlin, Germany) · 2023Article
- Hyperchloremia and association with acute kidney injury in critically ill children.Pediatric nephrology (Berlin, Germany) · 2023Article
- Hyperchloremia on Admission to Pediatric Intensive Care in Mechanically Ventilated Children is Associated with Impaired Renal Function.Journal of pediatric intensive care · 2023Article
- Electrolyte derangements in critically ill children receiving balanced versus unbalanced crystalloid fluid resuscitation.BMC nephrology · 2022Observational
- Fluid bolus therapy in pediatric sepsis: a narrative review.European journal of medical research · 2022Review
- Association of early dysnatremia with mortality in the neonatal intensive care unit: results from the AWAKEN study.Journal of perinatology : official journal of the California Perinatal Association · 2022Article
- Pediatric Mortality and Acute Kidney Injury Are Associated with Chloride Abnormalities in Intensive Care Units in the United States: A Multicenter Observational Study.Journal of pediatric intensive care · 2022Article
- Association between the use of balanced fluids and outcomes in critically ill children: a before and after study.Critical care (London, England) · 2021Article
- Effects of hyperchloremia on renal recovery in critically ill children with acute kidney injury.Pediatric nephrology (Berlin, Germany) · 2020Article
- Intravenous Fluid Prescription Practices in Critically Ill Children: A Shift in Focus from Natremia to Chloremia?Journal of pediatric intensive care · 2019Article
- Pragmatic Pediatric Trial of Balanced Versus Normal Saline Fluid in Sepsis: The PRoMPT BOLUS Randomized Controlled Trial Pilot Feasibility Study.Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2019Article
- Is dyschloremia a marker of critical illness or euchloremia an interventional target to improve outcomes?Annals of translational medicine · 2019Article
- Ab-normal saline in abnormal kidney function: risks and alternatives.Pediatric nephrology (Berlin, Germany) · 2019Review
- Increase in chloride from baseline is independently associated with mortality in critically ill children.Intensive care medicine · 2018Article
- Successful Rescue of Deep Coma, Shock, and Arrhythmia Caused by Bittern Poisoning.Journal of emergencies, trauma, and shockArticle
Corrections and comments
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Authors and funding
9 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe optimal fluid management in critically ill children is currently under investigation with several studies suggesting that hyperchloremia, chloride load, and the use of chloride-rich fluids contribute to worse outcomes.
methodsThis is a single-center retrospective cohort study of Pediatric Intensive Care Unit patients from 2008 to 2016 requiring continuous renal replacement therapy (CRRT). Patients were excluded if they had end-stage renal disease, a disorder of chloride transport, or concurrent provision of extracorporeal membrane oxygenation therapy.
resultsPatients (n = 66) were dichotomized into two groups (peak chloride (Cl) ≥ 110 mmol/L vs. peak Cl < 110 mmol/L prior to CRRT initiation). Hyperchloremia was present in 39 (59%) children. Baseline characteristics were similar between groups. Fluid overload at CRRT initiation was more common in patients with hyperchloremia (11.5% IQR 3.8-22.4) compared to those without (5.5% IQR 0.9-13.9) (p = 0.04). Mortality was significantly higher in patients with hyperchloremia (n = 26, 67%) compared to those without (n = 8, 29%) (p = 0.006). Patients with hyperchloremia had 10.9 times greater odds of death compared to those without hyperchloremia, after adjusting for percent fluid overload, PRISM III score, time to initiation of CRRT, height, and weight (95% CI 2.4 to 49.5, p = 0.002).
conclusionsHyperchloremia is common among critically ill children prior to CRRT initiation. In this population, hyperchloremia is independently associated with mortality. Further studies are needed to determine the impact of hyperchloremia on all critically ill children and the impact of chloride load on outcomes.
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Registered trials
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