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Acute kidney injury (AKI) is a common and serious hospital-acquired condition associated with high morbidity, mortality, and progression to chronic kidney disease (CKD). Recent evidence suggests that dyschloremia may influence renal outcomes, yet local data on its prognostic role remain scarce.
A hospital-based cohort study was conducted from January to December 2024 among 159 admitted adults meeting KDIGO criteria for AKI. Clinical and laboratory data were reviewed, and serum chloride levels on admission were classified as hypochloremia (<98 mEq/L), normochloremia (98–106 mEq/L), or hyperchloremia (>106 mEq/L). MAKE—defined as a composite of new or progressive CKD, end-stage kidney disease, or death—was the primary outcome. Associations were analyzed using Chi-square tests and binary logistic regression; p < 0.05 was considered significant.
Of 159 patients, 56.6% developed MAKE. Hypochloremia occurred in 84.4% of affected patients and was significantly associated with MAKE (p < 0.001). Logistic regression showed that hypochloremic patients were 72 times more likely to develop MAKE than normochloremic patients (OR = 72.20; 95% CI 24.80–210.24; p < 0.001). Hyperchloremia showed a nonsignificant trend toward higher risk (OR = 3.80; 95% CI 0.91–15.92; p = 0.068).
Table 1.1 Clinical and demographic profile among AKI patients with MAKE admitted at RTR Hospital (n= 90)
CLINICAL & DEMOGRAPHIC CHARACTERISTICS
FREQUENCY
PERCENTAGE
Age
o 19 – 39 y/o
1
1.1
o 40 – 69 y/o
42
46.7
o ≥70 y/o
47
52.2
Sex
o Female
34
37.8
o Male
56
62.2
Comorbidities
o Hypertension
71
78.89
o Type II Diabetes Mellitus
43
47.78
o Chronic Kidney Disease
28
31.11
o Heart Failure
36
40
o Myocardial Infarction
11
12.22
O Polycystic Kidney Disease/ Hereditary Glomerulopathies
4
4.44
o Urinary Tract Infection
17
18.89
o Sepsis/Shock
62.22
o Stroke
22
24.44
o Liver Disease
5
5.56
o Malignancy
7
7.78
o Autoimmune Disease
2
2.22
o Obstruction (e.g stones, BPH, etc.)
16
17.78
In-hospital Outcomes
o Progression of CKD
48
53.3
o RRT
3
3.3
o RRT/Death
o Death
38
42.2
Table 2. Chloride status among AKI patients with MAKE admitted at RTR Hospital (n= 90)
CHLORIDE LEVEL
Hypochloremia
76
84.4
Normochloremia
10
11.1
Hyperchloremia
4.4
Table 3.1 association between chloride status upon admission and the occurrence of MAKE among AKI patients admitted at RTR Hospital (n=159)
OCCURRENCE OF MAKE
p-value
WITHOUT MAKE (n,%)
WITH MAKE (n,%)
Total
6 (7.3%)
76 (92.7%)
82
<0.001*
57 (85.1%)
10 (14.9%)
67
6 (60.0%)
4 (40.0%)
69 (43.4%)
90 (56.6%)
159
*=significant at α=0.05
A striking observation in this study was the high prevalence of hypochloremia, affecting over four-fifths of AKI patients with MAKE. Statistical testing confirmed a significant association between hypochloremia and the occurrence of MAKE. Logistic regression analysis further demonstrated that hypochloremic patients were 72 times more likely to develop MAKE compared to those with normal chloride levels, establishing a strong association between hypochloremia and poor renal outcomes. Although hyperchloremia showed an increased risk trend, it did not reach statistical significance.
These findings underscore the critical role of serum chloride balance in the clinical course and possible adverse renal outcomes among AKI patients. Hypochloremia which is significantly associated with MAKE, but is often overlooked in routine assessments, may serve as an early marker of renal vulnerability and disease progression. Recognizing and promptly addressing this electrolyte disturbance could be pivotal in preventing or mitigating adverse kidney outcomes.
