Serum Chloride Levels as a Predictor of Mortality and renal recovery in Critically Ill Patients with Acute Kidney Injury (AKI): A Prospective Observational Study | ||
ARCADEs of MEDICINE | ||
Articles in Press, Accepted Manuscript, Available Online from 21 October 2025 | ||
Document Type: Original Research | ||
DOI: 10.21608/arcmed.2025.400117.1142 | ||
Authors | ||
Mohamed Moawad1; ahmed Elbakry2; Amr Ahmed Taher* 3; Omar Wagdy1; Amr Said1; Azza mohamed lotfy4 | ||
1Armed forces college of medicine | ||
2Head of Critical Care Medicine Department .Kobry Elkoba Military Hospital, Cairo, Egypt | ||
3Faculty of pharmacy cairo university (clinical pharmacy program) | ||
4intensive care , Armed Forces collage of medicine | ||
Abstract | ||
Background: Chloride homeostasis is primarily regulated by the kidneys. Dyschloremia has been associated with poor outcomes in intensive care units and cardiac care settings. It has also been identified as an independent prognostic factor in patients with hypertension, decompensated cirrhosis, chronic heart failure, chronic kidney disease, and in pediatric populations. However, a causal relationship between hyperchloremia and renal recovery following acute kidney injury (AKI) has not been established. Aim: This study aimed to evaluate the association between elevated chloride concentrations, mortality, and renal recovery in critically ill patients with AKI. Methods: In this prospective study conducted at Kobri El-Kobba Hospital ICU, 66 AKI patients were enrolled and followed. Serum chloride levels were measured on days 0, 3, and 7 after ICU admission. Based on clinical outcomes, patients were categorized into two groups: those who recovered from AKI (n=33) and those who did not recover and died (n=33). AKI and chronic kidney disease (CKD) were distinguished through clinical history and ultrasound findings. Results: Non-survivors had significantly higher serum chloride levels than survivors: day 1 (106.2 vs. 91.8 mmol/L), day 3 (114.7 vs. 90.2 mmol/L), and day 7 (117.3 vs. 92.4 mmol/L); all p = 0.001. Logistic regression identified average chloride levels as a significant predictor of mortality (OR = 0.709, p = 0.002) and renal recovery (OR = 0.875, p = 0.008). Conclusion: Elevated chloride concentrations were associated with increased mortality and reduced renal recovery, supporting the prognostic role of chloride in critically ill patients with AKI | ||
Keywords | ||
Acute kidney injury; Chloride concentration; mortality; electrolytes; hemostasis | ||
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