Association of perioperative hyperchloremia and hyperchloremic metabolic acidosis with acute kidney injury after craniotomy for intracranial hemorrhage.

Association of perioperative hyperchloremia and hyperchloremic metabolic acidosis with acute kidney injury after craniotomy for intracranial hemorrhage.

World Neurosurg. 2019 Feb 21;:

Authors: Oh TK, Jeon YT, Sohn H, Chung SH, Do SH

Abstract
BACKGROUND: This study aimed to evaluate relationships between perioperative hyperchloremic metabolic acidosis (HCA), hyperchloremia, and postoperative acute kidney injury (AKI) in patients who underwent craniotomy for intracranial hemorrhage.
METHOD: This retrospective cohort study included adult patients who underwent craniotomy for traumatic or spontaneous intracranial hemorrhage between January 2005 and December 2017. Association of perioperative hyperchloremia (serum chloride [Cl-] > 110 mmol L-1 during postoperative days [POD] 0-3), increase in Cl- levels (maximum Cl- level in POD 0-3- baseline Cl- level before surgery), and perioperative HCA (Cl- > 110 mmol L-1, pH < 7.35 with a bicarbonate level < 24 mmol L-1) with AKI incidence were analyzed using multivariable logistic regression analysis.
RESULTS: Nine-hundred-sixty-eight patients were included; 117 (12.1%) had postoperative AKI. The multivariable logistic regression analysis showed that exposure to HCA was associated with 1.850-fold increase of postoperative AKI (odds ratio [OR]: 1.850, 95% confidence interval [CI]: 1.102-3.106; P=0.020), while hyperchloremia was not significantly related to postoperative AKI (P = 0.207). Additionally, both exposure to hyperchloremia and increase in Cl- levels were associated with increased exposure to HCA (hyperchloremia group OR: 2.162, 95% CI: 1.490-3.138, P<0.001; OR of a 1 mmol L-1 increase in Cl- levels: 1.035, 95% CI: 1.008-1.062, P=0.011).
CONCLUSIONS: Perioperative HCA exposure was independently related to an increased incidence of AKI after craniotomy for intracranial hemorrhage. Increase in Cl- levels and perioperative hyperchloremia exposure were associated with increased exposure to HCA but were not significantly related to postoperative AKI.

PMID: 30797920 [PubMed - as supplied by publisher]

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