Impact of hyperchloremia and its relationship with serum cystatin C level as a marker of Early acute renal injury during the treatment of Diabetic Ketoacidosis

Document Type : Original Article

Authors

1 Internal Medicine, Faculty of Medicine, Al-Azhar University, Cairo, Egypt

2 Clinical Pathology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt

10.21608/aimj.2025.403598.2649

Abstract

Background: There has been growing recognition of hyperchloremic metabolic acidosis as a cause of in-hospital acute kidney injury (AKI) and increased serum cystatin C as a sensitive and early indicator of renal dysfunction. This acidosis typically occurs after the administration of 0.9% sodium chloride to treat diabetic ketoacidosis (DKA).
Aim of the work: Whether hyperchloremia is connected with increased rates of in-hospital AKI development, how long it takes for DKA to resolve, and how long patients spend in the intensive care unit (LOS), as well as to look at the correlation between high blood cystatin C concentrations and increased serum chloride levels, which could indicate the beginning of acute kidney injury.
Subjects and methods:  This prospective observational study was carried out on 60-patients with DKA admitted to Al-Azhar University Hospitals, from May 2023 till January 2025. Patients were divided randomly into: Group-A hyperchloremia Group-I (n=30) and Normochloremia Group-II (n=30).
 Results: Group I with hyperchloremia had a much longer time to first and final DKA resolution compared to Group II with sustained normochloremia. Compared to Group-II, which maintained normochloremia, Group-I hyperchloremia patients were more likely to experience in-hospital AKI, intensive care unit admission, and length of stay. Group I, which had hyperchloremia, had a considerably greater serum cystatin C level compared to Group II, which maintained normochloremia.
Conclusion: It is commonly believed that the administration of a 0.9% sodium chloride solution during the management of DKA is the cause of hyperchloremic metabolic acidosis, which is related with the development of in-hospital AKI in patients with DKA. The duration of hospital stay and the time it takes for DKA to resolve have both been linked to this acid-base imbalance.

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