Safety analysis regarding acute kidney injuries for chloride-restrictive intravenous fluid administration against that of chloride-liberal for patients admitted in the medical intensive care unit: A non-randomised retrospective (chrachl-mic) study

Int J Clin Pract. 2021 May;75(5):e13972. doi: 10.1111/ijcp.13972. Epub 2021 Jan 12.


Background: Acute 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.

Methods: Data 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.

Results: Patients 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).

Conclusion: The chloride-restrictive intravenous fluid administration has reduced the chances of acute kidney injuries in the intensive medical care unit.

Keywords: KDIGO stage; RIFLE categories; acute kidney injuries; chloride-liberal intravenous fluid; chloride-restrictive intravenous fluid; intensive medical care unit; renal replacement therapy; serum creatinine.

MeSH terms

  • Acute Kidney Injury* / therapy
  • Chlorides*
  • Critical Illness / therapy
  • Hospitalization
  • Humans
  • Intensive Care Units
  • Retrospective Studies


  • Chlorides