• Logo
  • SBMUJournals

Correlation of Hyperchloremic Metabolic Acidosis and Renal Function in Critically ill Patients of Emergency Department: an Observational Study

Mauro Giordano, Tiziana Ciarambino, Pietro Castellino, Lorenzo Malatino, Giuseppe Signoriello, Giuseppe Paolisso, Luigi Elio Adinolfi




Introduction: Early detection is crucial for prompt management of acute kidney injury (AKI) patients in emergency department (ED). This study aimed to investigate the usefulness of hyperchloremic metabolic acidosis (HCMA) levels in this regard.

 Methods: In this retrospective observational study, > 18 years old critically ill patients presenting to ED of Marcianise Hospital, Italy, were divided into non-AKI and AKI group according to KDIGO guideline. The level of HCMA ((arterial pH x bicarbonate)/chloride) was compared between groups and correlation of HCMA with estimated glomerular filtration rate (e-GFR) in ARF patients was evaluated.

Results: 134 patients with the mean age of 76.5 ± 3.1 years were enrolled (64 non-AKI and 70 AKI; 64% female). Two groups were similar regarding mean age (p = 0.251), sex (p = 0.091), APACHII score (p = 0.215), Charlson Comorbidity Index (p= 0.187), and body mass index (p = 0.129). The mean HCMA level was 1.98 ± 0.09 in the non-AKI group and 1.56 ± 0.07 in the AKI group (p=0.039). There was a positive correlation between HCMA and e-GFR levels in AKI group (r: 0.467, p=0.0092).

Conclusions: If confirmed and validated in a future study, ABG derived formula for HCMA may be a useful tool for early detection of AKI patients in emergency department.


Acute kidney injury; hyperchloremic metabolic acidosis; emergency department; renal function


Li PKT, Burdmann EA, Mehta RL. Acute kidney injury: global health alert. Arab journal of nephrology and transplantation. 2013;6(2):75-81.

Scheuermeyer FX, Grafstein E, Rowe B, Cheyne J, Grunau B, Bradford A, et al. The clinical epidemiology and 30-day outcomes of emergency department patients with acute kidney injury. Canadian journal of kidney health and disease. 2017;4:2054358117703985.

Kellum JA, Lameire N, Aspelin P, Barsoum RS, Burdmann EA, Goldstein SL, et al. Kidney disease: improving global outcomes (KDIGO) acute kidney injury work group. KDIGO clinical practice guideline for acute kidney injury. Kidney international supplements. 2012;2(1):1-138.

Noritomi DT, Soriano FG, Kellum JA, Cappi SB, Biselli PJ, Libório AB, et al. Metabolic acidosis in patients with severe sepsis and septic shock: a longitudinal quantitative study. Critical care medicine. 2009;37(10):2733-9.

Stewart PA. Modern quantitative acid–base chemistry. Canadian journal of physiology and pharmacology. 1983;61(12):1444-61.

Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. Journal of chronic diseases. 1987;40(5):373-83.

Zimmerman JE, Kramer AA, McNair DS, Malila FM. Acute Physiology and Chronic Health Evaluation (APACHE) IV: hospital mortality assessment for today’s critically ill patients. Critical care medicine. 2006;34(5):1297-310.

Levey AS, Becker C, Inker LA. Glomerular filtration rate and albuminuria for detection and staging of acute and chronic kidney disease in adults: a systematic review. Jama. 2015;313(8):837-46.

Hoste EA, Bagshaw SM, Bellomo R, Cely CM, Colman R, Cruz DN, et al. Epidemiology of acute kidney injury in critically ill patients: the multinational AKI-EPI study. Intensive care medicine. 2015;41(8):1411-23.

Bouchard J, Acharya A, Cerda J, Maccariello ER, Madarasu RC, Tolwani AJ, et al. A prospective international multicenter study of AKI in the intensive care unit. Clinical Journal of the American Society of Nephrology. 2015:CJN. 04360514.

Toyonaga Y, Kikura M. Hyperchloremic acidosis is associated with acute kidney injury after abdominal surgery. Nephrology. 2017;22(9):720-7.

Bockenkamp B, Vyas H. Understanding and managing acute fluid and electrolyte disturbances. Current Paediatrics. 2003;13(7):520-8.

Relman AS, Lennon EJ, Lemann J. Endogenous production of fixed acid and the measurement of the net balance of acid in normal subjects. The Journal of clinical investigation. 1961;40(9):1621-30.

Widmer B, Gerhardt RE, Harrington JT, Cohen JJ. Serum electrolyte and acid base composition: the influence of graded degrees of chronic renal failure. Archives of internal medicine. 1979;139(10):1099-102.

Wright G, Noiret L, Damink SWO, Jalan R. Interorgan ammonia metabolism in liver failure: the basis of current and future therapies. Liver International. 2011;31(2):163-75.

DOI: https://doi.org/10.22037/emergency.v6i1.21610

Data citation



  • There are currently no refbacks.