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Does Chloride Intake at The Early Phase of Septic Shock Resuscitation Impact on Renal Outcome?

INTRODUCTION
Fluid administration is one of the first line of treatment for hemodynamic management of sepsis and septic shock. Studies investigating the effects of chloride-rich fluids including normal saline on renal function report controversial findings.


METHODS
This is a prospective, observational, multicenter study. Patients with septic shock, defined according to Sepsis-2 definition were eligible. A "high-dose" of chloride was defined as a chloride intake greater than 18 g administrated within the first 48 h of septic shock management. The purpose of this study was to investigate the impact of cumulative chloride infusion within the first 48 hours of septic shock resuscitation on acute kidney injury (AKI).


RESULTS
239 patients with septic shock were included. Patients who received a "high-dose" of chloride had significantly higher SOFA score at the time of enrolment (p < 0.001). Cumulative chloride load was higher in patients requiring RRT (31.1 vs. 25.2 g/48 hours; p < 0.005). Propensity score weighted regression did not found any association between "high-dose" of chloride and AKI requiring RRT (OR: 0.97 [0.88 - 1.1]; p = 0.69). There was no association between "high-dose" of chloride and worsening kidney function at H48 (OR: 0.94 [0.83 - 1.1]; p = 0.42). There were also no association between "high-dose" of chloride and ICU length of stay (p = 0.61), 28-day mortality (p = 0.83) or hospital mortality (p = 0.89).


CONCLUSION
At the early stage of resuscitation of critically ill patients with septic shock, administration of "high-dose" of chloride (> 18 g/48 h) was not associated with renal prognosis.