• Li Huang, Yanqun Hu, Li Jia, Min Pang, Caiman Huang, Zhongyan Zhao, and Li Li.
• Department of neurology, Hainan General Hospitail (Hainan Affiliated Hospital of Hainan Medical University), Haikou, China.
• Int. J. Clin. Pract. 2021 May 1; 75 (5): e13972.

BackgroundAcute kidney injuries are common in the medical intensive care unit. Generally, intravenous normal saline is administered in critically ill patients but it is associated with acute kidney injury. Current knowledge of chloride and its effect on the physiological functions of the kidney is limited. The objectives of the study were to compare the safety of chloride-restrictive intravenous fluid administration against that of chloride-liberal regarding acute kidney injuries.MethodsData regarding RIFLE (risk, injury, failure, loss, and end-stage renal failure) categories, Kidney Disease: Improved Global Outcomes (KDIGO) stage, Δ creatinine, and requirements of renal replacement therapy of 285 patients admitted to medical intensive care unit for critical illness during 4-months from the hospitalisation were retrospectively collected and analysed. Patients received chloride-liberal intravenous fluid (CL cohort, n = 163) or that of chloride-restrictive (CR cohort, n = 122) during bundle-of-care.ResultsPatients with risk (P = .039) and injury (P = .041) categories of RIFLE, high Δ creatinine (0.22 ± 0.02 mg/dL/patient vs 0.18 ± 0.02 mg/dL/patient, P < .0001), and patients with KDIGO stage 1 (P = .023) and stage 2 (P = .048) were reported significantly higher in the CL cohort than the CR cohort. The higher numbers of patients were put on renal replacement therapy in the CL cohort than those of the CR cohort (16 vs 3, P = .014).ConclusionThe chloride-restrictive intravenous fluid administration has reduced the chances of acute kidney injuries in the intensive medical care unit.© 2020 John Wiley & Sons Ltd.

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