Baseline Chloride Levels are Associated with the Incidence of Contrast-Associated Acute Kidney Injury

Although hypo- and hyperchloremia have been associated with worsening renal outcomes, there has been no study that correlates hypo- and hyperchloremia and the incidence of contrast-associated acute kidney injury (CA-AKI). A total of 13,088 patients with less than 2.0 mg/dL of serum creatinine (Cr) who underwent contrast-enhanced abdominal CT (CECT) were included. Patients were divided into 3 groups based on Cl (the hypo-, normo- and hyperchloremia groups). Patients were also classified by baseline Cr (<1.2; the ‘Normal Cr group’ and 1.2–2.0 mg/dL; the ‘Slightly increased Cr group’). Multivariate logistic regression analysis was used to reveal the association between Cl and CA-AKI. Among patients, 2,525 (19.3%) and 241 (1.8%) patients were classified in the hypo- and hyperchloremia group. The incidence of CA-AKI was significantly lower in the normochloremia group (4.0%) compared to the hypo- (5.4%) and hyperchloremia groups (9.5%). On multivariate logistic regression, hypochloremia was significantly associated with the incidence of CA-AKI compared with normochloremia (1.382, P = 0.002). Moreover, hypochloremia was still significantly associated with the incidence of CA-AKI in ‘Normal Cr group’ compared with normochloremia (1.314, P = 0.015), while hyperchloremia did not show significant association with CA-AKI incidence. In conclusion, hypochloremia might be associated with the incidence of CA-AKI even in patients who have normal-range Cr levels.