The association between serum chloride levels and chronic kidney disease progression: a cohort study
Abstract Background Limited data suggest serum chloride levels associate with mortality in heart failure, chronic kidney disease (CKD), and pulmonary arterial hypertension. Randomized trials have also shown that administration of crystalloid intravenous fluids with lower chloride concentration may h...
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| Format: | Article |
| Language: | English |
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BMC
2020-05-01
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| Series: | BMC Nephrology |
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| Online Access: | http://link.springer.com/article/10.1186/s12882-020-01828-3 |
| _version_ | 1818511586421112832 |
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| author | Minesh Khatri Joshua Zitovsky Dale Lee Kamal Nayyar Melissa Fazzari Candace Grant |
| author_facet | Minesh Khatri Joshua Zitovsky Dale Lee Kamal Nayyar Melissa Fazzari Candace Grant |
| author_sort | Minesh Khatri |
| collection | DOAJ |
| description | Abstract Background Limited data suggest serum chloride levels associate with mortality in heart failure, chronic kidney disease (CKD), and pulmonary arterial hypertension. Randomized trials have also shown that administration of crystalloid intravenous fluids with lower chloride concentration may have better renal outcomes. However, chloride has not been studied longitudinally for CKD progression. Methods We used a prospective cohort of subjects with stage 3 and 4 CKD recruited from a nephrology clinic at a single medical center. Linear regression, linear regression with generalized estimating equations, and Cox proportional hazards models were created for outcomes of overall change in estimated glomerular filtration rate (eGFR), longitudinal changes in eGFR, and time to > 30% decline in eGFR, respectively. Baseline chloride was modeled continuously and categorically, and models were adjusted for potential confounders. Results Median follow-up was 1.7 years. Baseline median age was 72 years and median eGFR was 35.7 mL/min/1.73m 2 . In multivariable analysis, higher serum chloride associated with worsened eGFR decline. Every 1 mEq/L increase in chloride associated with an overall eGFR decline of 0.32 mL/min/1.73m 2 (p = 0.003), while the difference in eGFR decline in the highest quartile of chloride was 3.4 mL/min/1.73m 2 compared to the lowest quartile (p = 0.004). No association between serum chloride and time to 30% decline in eGFR was observed in multivariable analysis (hazard ratio 1.05 per 1 mEq/L increase in serum chloride, p = 0.103). Conclusions In CKD patients, higher serum chloride associated with a modestly steeper rate of eGFR decline, and may be a useful biomarker to predict CKD progression. Further studies are needed to determine causality. |
| first_indexed | 2024-12-10T23:35:08Z |
| format | Article |
| id | doaj.art-ef12a52f093842739ab6c27f597608ca |
| institution | Directory Open Access Journal |
| issn | 1471-2369 |
| language | English |
| last_indexed | 2024-12-10T23:35:08Z |
| publishDate | 2020-05-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Nephrology |
| spelling | doaj.art-ef12a52f093842739ab6c27f597608ca2022-12-22T01:29:13ZengBMCBMC Nephrology1471-23692020-05-0121111010.1186/s12882-020-01828-3The association between serum chloride levels and chronic kidney disease progression: a cohort studyMinesh Khatri0Joshua Zitovsky1Dale Lee2Kamal Nayyar3Melissa Fazzari4Candace Grant5Division of Nephrology, Department of Medicine, NYU Winthrop HospitalDepartment of Biostatistics, University of North CarolinaDepartment of Medicine, NYU Winthrop HospitalDivision of Nephrology, Department of Medicine, NYU Winthrop HospitalDepartment of Epidemiology and Population Health, Albert Einstein College of MedicineDivision of Nephrology, Department of Medicine, NYU Winthrop HospitalAbstract Background Limited data suggest serum chloride levels associate with mortality in heart failure, chronic kidney disease (CKD), and pulmonary arterial hypertension. Randomized trials have also shown that administration of crystalloid intravenous fluids with lower chloride concentration may have better renal outcomes. However, chloride has not been studied longitudinally for CKD progression. Methods We used a prospective cohort of subjects with stage 3 and 4 CKD recruited from a nephrology clinic at a single medical center. Linear regression, linear regression with generalized estimating equations, and Cox proportional hazards models were created for outcomes of overall change in estimated glomerular filtration rate (eGFR), longitudinal changes in eGFR, and time to > 30% decline in eGFR, respectively. Baseline chloride was modeled continuously and categorically, and models were adjusted for potential confounders. Results Median follow-up was 1.7 years. Baseline median age was 72 years and median eGFR was 35.7 mL/min/1.73m 2 . In multivariable analysis, higher serum chloride associated with worsened eGFR decline. Every 1 mEq/L increase in chloride associated with an overall eGFR decline of 0.32 mL/min/1.73m 2 (p = 0.003), while the difference in eGFR decline in the highest quartile of chloride was 3.4 mL/min/1.73m 2 compared to the lowest quartile (p = 0.004). No association between serum chloride and time to 30% decline in eGFR was observed in multivariable analysis (hazard ratio 1.05 per 1 mEq/L increase in serum chloride, p = 0.103). Conclusions In CKD patients, higher serum chloride associated with a modestly steeper rate of eGFR decline, and may be a useful biomarker to predict CKD progression. Further studies are needed to determine causality.http://link.springer.com/article/10.1186/s12882-020-01828-3Chronic kidney diseaseChlorideEpidemiology |
| spellingShingle | Minesh Khatri Joshua Zitovsky Dale Lee Kamal Nayyar Melissa Fazzari Candace Grant The association between serum chloride levels and chronic kidney disease progression: a cohort study BMC Nephrology Chronic kidney disease Chloride Epidemiology |
| title | The association between serum chloride levels and chronic kidney disease progression: a cohort study |
| title_full | The association between serum chloride levels and chronic kidney disease progression: a cohort study |
| title_fullStr | The association between serum chloride levels and chronic kidney disease progression: a cohort study |
| title_full_unstemmed | The association between serum chloride levels and chronic kidney disease progression: a cohort study |
| title_short | The association between serum chloride levels and chronic kidney disease progression: a cohort study |
| title_sort | association between serum chloride levels and chronic kidney disease progression a cohort study |
| topic | Chronic kidney disease Chloride Epidemiology |
| url | http://link.springer.com/article/10.1186/s12882-020-01828-3 |
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