Association between serum chloride and mortality in patients on maintenance hemodialysis: The Osaka Dialysis Complication Study (ODCS)

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Association between serum chloride and mortality in patients on maintenance hemodialysis: The Osaka Dialysis Complication Study (ODCS)

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Co-author 1

Tetsuo Shoji tetsuoshoji@omu.ac.jp Inoue Hospital Clinical Research Center Suita Japan * Osaka Metropolitan University Graduate School of Medicine Department of Metabolism, Endocrinology and Molecular Medicine Osaka Japan Osaka Metropolitan University Graduate School of Medicine Department of Vascular Medicine Osaka Japan

Co-author 2

Rino Nakaya 828rino828@gmail.com Osaka Metropolitan University Graduate School of Medicine Department of Metabolism, Endocrinology and Molecular Medicine Osaka Japan -

Co-author 3

Shinya Nakatani nakatani-s@omu.ac.jp Osaka Metropolitan University Graduate School of Medicine Department of Nephrology Osaka Japan -

Co-author 4

Yuki Nagata yuki.nagata@omu.ac.jp Osaka Metropolitan University Graduate School of Medicine Department of Vascular Medicine Osaka Japan - Osaka Metropolitan University Graduate School of Medicine Vascular Science Center for Translational Research Osaka Japan

Co-author 5

Katsuhito Mori ktmori@med.kindai.ac.jp Kindai University Nara Hospital Department of Endocrinology, Metabolism, and Diabetes Ikoma Japan -

Co-author 6

Hisako Fujii hfujii@omu.ac.jp Osaka Metropolitan University Graduate School of Medicine Department of Health and Medical Innovation Osaka Japan -

Co-author 7

Tomoaki Morioka moriokatmed@omu.ac.jp Osaka Metropolitan University Graduate School of Medicine Department of Metabolism, Endocrinology and Molecular Medicine Osaka Japan -

Co-author 8

Yasuo Imanishi imanishig@gmail.com Osaka Metropolitan University Graduate School of Medicine Department of Vascular Medicine Osaka Japan - Osaka Metropolitan University Graduate School of Medicine Vascular Science Center for Translational Research Osaka Japan

Co-author 9

Masanori Emoto emoto-m@omu.ac.jp Osaka Metropolitan University Graduate School of Medicine Department of Metabolism, Endocrinology and Molecular Medicine Osaka Japan - Osaka Metropolitan University Graduate School of Medicine Department of Nephrology Osaka Japan Osaka Metropolitan University Graduate School of Medicine Vascular Science Center for Translational Research Osaka Japan

Co-author 10

Co-author 11

Co-author 12

Co-author 13

Co-author 14

Co-author 15

Introduction

Recent studies have shown that a lower level of serum chloride (CL) is a predictor of all-cause mortality (ACM) in patient groups with heart failure or chronic kidney disease, although it is unknown whether such an association is present in those on maintenance hemodialysis (MHD).

Methods

This was a prospective cohort study in 1653 patients on MHD. The key exposure was CL, and the outcome was ACM during 5-years of follow-up.

Results

The median (IQR) age and dialysis duration were 68 (60, 75) years and 64 (29, 133) months, respectively. The cohort was divided into tertiles based on CL (T1, 86-100 mEq/L, N = 544; T2, 101-103 mEq/L, N = 508; T3, 104-116 mEq/L, N = 601). We identified 467 cases with ACM. Kaplan-Meier analysis showed an inverse association between CL and ACM. The inverse association was significant even in Cox regression analysis adjusted for 24 potential confounders with the hazard ratio [95%CI] of1.69 [1.34, 2.13] for T1 and 1.37 [1.08, 1.74] for T2 as compared to T3. The inverse association was consistent across various subgroups and remained significant after additional adjustment for serum Na, K, use of RASi, and use of loop diuretics.

Conclusion

A lower serum CL is a novel and independent predictor of ACM in patients on MHD. Further studies are needed to elucidate the mechanisms behind the observed association and to clarify the clinical impact of this observation.

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